13D0997242 CLIA NUMBER - FRED MEYER PHARMACY #662

Laboratory Demographics

  • CLIA Code: 13D0997242
  • Facility Name: FRED MEYER PHARMACY #662
  • Facility Address: 5230 W FRANKLIN RD
    BOISE, ID
    ZIP 83705
  • Facility Phone: 208 429-6433
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREI RUDYI
  • NPI Number: 1376588442
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D0997242
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #662
Street 5230 W FRANKLIN RD
City BOISE
State ID
ZIP 83705
Phone 208 429-6433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2024
Certificate Expiration Date 3/10/2026
Facility Type Pharmacy
Lab Director ANDREI RUDYI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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