13D1007527 CLIA NUMBER - FRED MEYER PHARMACY #383

Laboratory Demographics

  • CLIA Code: 13D1007527
  • Facility Name: FRED MEYER PHARMACY #383
  • Facility Address: 705 BLUE LAKES BLVD N
    TWIN FALLS, ID
    ZIP 83301
  • Facility Phone: (208) 736-5373
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY J. VAUGHN
  • NPI Number: 1043256951
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D1007527
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #383
Street 705 BLUE LAKES BLVD N
City TWIN FALLS
State ID
ZIP 83301
Phone 2087365373
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Pharmacy
Lab Director ANTHONY J. VAUGHN

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This page was last updated on: 5/18/2026