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13D0970914 CLIA NUMBER - FRED MEYER PHARMACY #260

Laboratory Demographics

CLIA Number: 13D0970914

Facility Name: FRED MEYER PHARMACY #260

Facility Address:
800 YELLOWSTONE HWY
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 239-4033

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1740225275

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType 4
CertificateEffectiveDate 2/29/2024
CertificateExpirationDate 2/27/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024