13D1094134 CLIA NUMBER - FRED MEYER PHARMACY #439

Laboratory Demographics

  • CLIA Code: 13D1094134
  • Facility Name: FRED MEYER PHARMACY #439
  • Facility Address: 10751 W OVERLAND RD
    BOISE, ID
    ZIP 83709
  • Facility Phone: 208 373-5233
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL DAVIDSON
  • NPI Number: 1134165046
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2025
Certificate Expiration Date 1/11/2027
Facility Type Pharmacy
Lab Director PAUL DAVIDSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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