13D1035486 CLIA NUMBER - ALBERTSON'S PHARMACY #0199

Laboratory Demographics

  • CLIA Code: 13D1035486
  • Facility Name: ALBERTSON'S PHARMACY #0199
  • Facility Address: 1219 S BROADWAY AVE
    BOISE, ID
    ZIP 83706
  • Facility Phone: 208 433-9905
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY FLYNN
  • NPI Number: 1457880940
  • Taxonomy: 133V00000X - Dietitian, Registered

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CLIA Record

Field Name Field Value
CLIA Number 13D1035486
LAB Type Pharmacy
Facility Name ALBERTSON'S PHARMACY #0199
Street 1219 S BROADWAY AVE
City BOISE
State ID
ZIP 83706
Phone 208 433-9905
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Pharmacy
Lab Director TIMOTHY FLYNN

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