13D2010783 CLIA NUMBER - SMITH'S PHARMACY #123

Laboratory Demographics

  • CLIA Code: 13D2010783
  • Facility Name: SMITH'S PHARMACY #123
  • Facility Address: 937 E MAIN ST
    BURLEY, ID
    ZIP 83318
  • Facility Phone: 208 378-3286
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAIME MONTUORO
  • NPI Number: 1699790212
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2010783
LAB Type Pharmacy
Facility Name SMITH'S PHARMACY #123
Street 937 E MAIN ST
City BURLEY
State ID
ZIP 83318
Phone 208 378-3286
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Pharmacy
Lab Director JAIME MONTUORO

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This page was last updated on: 3/20/2025