13D1036468 CLIA NUMBER - SAFEWAY PHARMACY #0254

Laboratory Demographics

  • CLIA Code: 13D1036468
  • Facility Name: SAFEWAY PHARMACY #0254
  • Facility Address: 161 W PRAIRIE AVE
    HAYDEN, ID
    ZIP 83835
  • Facility Phone: 208 772-7864
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY FLYNN
  • NPI Number: 1194771600
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D1036468
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0254
Street 161 W PRAIRIE AVE
City HAYDEN
State ID
ZIP 83835
Phone 208 772-7864
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Pharmacy
Lab Director TIMOTHY FLYNN

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