13D0977339 CLIA NUMBER - FRED MEYER PHARMACY #049

Laboratory Demographics

  • CLIA Code: 13D0977339
  • Facility Name: FRED MEYER PHARMACY #049
  • Facility Address: 560 W KATHLEEN AVE
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: 208 665-4733
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAREN KOENIG
  • NPI Number: 1952347866
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D0977339
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #049
Street 560 W KATHLEEN AVE
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 665-4733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2024
Certificate Expiration Date 8/23/2026
Facility Type Pharmacy
Lab Director KAREN KOENIG

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