13D2033253 CLIA NUMBER - WALGREEN'S #11083

Laboratory Demographics

  • CLIA Code: 13D2033253
  • Facility Name: WALGREEN'S #11083
  • Facility Address: 6195 S FIVE MILE RD
    BOISE, ID
    ZIP 83709
  • Facility Phone: 208 319-0191
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUZETTE B. JACOBS
  • NPI Number: 1477870103
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2033253
LAB Type Pharmacy
Facility Name WALGREEN'S #11083
Street 6195 S FIVE MILE RD
City BOISE
State ID
ZIP 83709
Phone 208 319-0191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Pharmacy
Lab Director SUZETTE B. JACOBS

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