13D0985335 CLIA NUMBER - FRED MEYER PHARMACY #613

Laboratory Demographics

CLIA Number: 13D0985335

Facility Name: FRED MEYER PHARMACY #613

Facility Address:
3527 S FEDERAL WAY
BOISE, ID
ZIP 83705
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Facility Phone Number: 208 424-7533

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1902842594

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	13D0985335
LAB Type	Pharmacy
Facility Name	FRED MEYER PHARMACY #613
Street	3527 S FEDERAL WAY
City	BOISE
State	ID
ZIP	83705
Phone	208 424-7533
CertificateType	4
CertificateEffectiveDate	4/16/2023
CertificateExpirationDate	4/15/2025
FacilityType	Waiver

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