13D1094135 CLIA NUMBER - FRED MEYER PHARMACY #198

Laboratory Demographics

  • CLIA Code: 13D1094135
  • Facility Name: FRED MEYER PHARMACY #198
  • Facility Address: 1850 E FAIRVIEW AVE
    MERIDIAN, ID
    ZIP 83642
  • Facility Phone: 208 887-5273
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAVI PATEL
  • NPI Number: 1659316180
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D1094135
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #198
Street 1850 E FAIRVIEW AVE
City MERIDIAN
State ID
ZIP 83642
Phone 208 887-5273
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 RAVI PATEL

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