13D2019640 CLIA NUMBER - RIDLEY'S PHARMACY #8445

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Laboratory Demographics

CLIA Number: 13D2019640

Facility Name: RIDLEY'S PHARMACY #8445

Facility Address:
1427 MAIN ST
GOODING, ID
ZIP 83330
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Facility Phone Number: 208 934-4709

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1316072630

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	13D2019640
LAB Type	Pharmacy
Facility Name	RIDLEY'S PHARMACY #8445
Street	1427 MAIN ST
City	GOODING
State	ID
ZIP	83330
Phone	208 934-4709
CertificateType	4
CertificateEffectiveDate	2/3/2023
CertificateExpirationDate	2/2/2025
FacilityType	Waiver

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