13D0970914 CLIA NUMBER - FRED MEYER PHARMACY #260

Laboratory Demographics

  • CLIA Code: 13D0970914
  • Facility Name: FRED MEYER PHARMACY #260
  • Facility Address: 800 YELLOWSTONE HWY
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 239-4033
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RIKKI TRUSSEL
  • NPI Number: 1740225275
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D0970914
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #260
Street 800 YELLOWSTONE HWY
City POCATELLO
State ID
ZIP 83201
Phone 208 239-4033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Pharmacy
Lab Director RIKKI TRUSSEL

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