13D2019665 CLIA NUMBER - RIDLEY'S PHARMACY #7152

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Laboratory Demographics

CLIA Number: 13D2019665

Facility Name: RIDLEY'S PHARMACY #7152

Facility Address:
911 N MAIN ST
POCATELLO, ID
ZIP 83204
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Facility Phone Number: 208 478-8510

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1114053444

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	13D2019665
LAB Type	Pharmacy
Facility Name	RIDLEY'S PHARMACY #7152
Street	911 N MAIN ST
City	POCATELLO
State	ID
ZIP	83204
Phone	208 478-8510
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