13D0940005 CLIA NUMBER - FRED MEYER PHARMACY #449

Laboratory Demographics

  • CLIA Code: 13D0940005
  • Facility Name: FRED MEYER PHARMACY #449
  • Facility Address: 5425 CHINDEN BLVD
    BOISE, ID
    ZIP 83714
  • Facility Phone: 208 323-7005
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DENNIS PERRY
  • NPI Number: 1316983224
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D0940005
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #449
Street 5425 CHINDEN BLVD
City BOISE
State ID
ZIP 83714
Phone 208 323-7005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2024
Certificate Expiration Date 2/2/2026
Facility Type Pharmacy
Lab Director DENNIS PERRY

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This page was last updated on: 9/29/2025