13D1045240 CLIA NUMBER - WHITE CROSS PHARMACY - PRIEST RIVER

Laboratory Demographics

CLIA Number: 13D1045240

Facility Name: WHITE CROSS PHARMACY - PRIEST RIVER

Facility Address:
5453 HIGHWAY 2
PRIEST RIVER, ID
ZIP 83856
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Facility Phone Number: 208 448-1633

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1891783668

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	13D1045240
LAB Type	Pharmacy
Facility Name	WHITE CROSS PHARMACY - PRIEST RIVER
Street	5453 HIGHWAY 2
City	PRIEST RIVER
State	ID
ZIP	83856
Phone	208 448-1633
CertificateType	4
CertificateEffectiveDate	9/9/2023
CertificateExpirationDate	9/8/2025
FacilityType	Waiver

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