13D2033065 CLIA NUMBER - WALGREENS #05185

Laboratory Demographics

  • CLIA Code: 13D2033065
  • Facility Name: WALGREENS #05185
  • Facility Address: 4924 OVERLAND RD
    BOISE, ID
    ZIP 83705
  • Facility Phone: 208 336-1728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IAN M. BOROVATZ
  • NPI Number: 1699780718
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2033065
LAB Type Pharmacy
Facility Name WALGREENS #05185
Street 4924 OVERLAND RD
City BOISE
State ID
ZIP 83705
Phone 208 336-1728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director IAN M. BOROVATZ

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