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13D1007527 CLIA NUMBER - FRED MEYER PHARMACY #383

Laboratory Demographics

CLIA Number: 13D1007527

Facility Name: FRED MEYER PHARMACY #383

Facility Address:
705 BLUE LAKES BLVD N
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 736-5373

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1043256951

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 13D1007527
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #383
Street 705 BLUE LAKES BLVD N
City TWIN FALLS
State ID
ZIP 83301
Phone 208 736-5373
CertificateType 4
CertificateEffectiveDate 12/20/2022
CertificateExpirationDate 12/19/2024
FacilityType Waiver

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