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13D1094134 CLIA NUMBER - FRED MEYER PHARMACY #439

Laboratory Demographics

CLIA Number: 13D1094134

Facility Name: FRED MEYER PHARMACY #439

Facility Address:
10751 W OVERLAND RD
BOISE, ID
ZIP 83709
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Facility Phone Number: 208 373-5233

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1134165046

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 13D1094134
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #439
Street 10751 W OVERLAND RD
City BOISE
State ID
ZIP 83709
Phone 208 373-5233
CertificateType 4
CertificateEffectiveDate 1/12/2023
CertificateExpirationDate 1/11/2025
FacilityType Waiver

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