13D2011157 CLIA NUMBER - SAFEWAY PHARMACY #0383

Laboratory Demographics

  • CLIA Code: 13D2011157
  • Facility Name: SAFEWAY PHARMACY #0383
  • Facility Address: 1320 S BLAINE ST
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 882-2663
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY FLYNN
  • NPI Number: 1073559696
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2011157
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0383
Street 1320 S BLAINE ST
City MOSCOW
State ID
ZIP 83843
Phone 208 882-2663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Pharmacy
Lab Director TIMOTHY FLYNN

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