13D2033082 CLIA NUMBER - WALGREEN'S #05565

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Laboratory Demographics

CLIA Number: 13D2033082

Facility Name: WALGREEN'S #05565

Facility Address:
10555 W OVERLAND ROAD
BOISE, ID
ZIP 83709
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Facility Phone Number: 208 321-2669

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1508871625

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	13D2033082
LAB Type	Pharmacy
Facility Name	WALGREEN'S #05565
Street	10555 W OVERLAND ROAD
City	BOISE
State	ID
ZIP	83709
Phone	208 321-2669
CertificateType	4
CertificateEffectiveDate	10/18/2023
CertificateExpirationDate	10/17/2025
FacilityType	Waiver

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