13D2033514 CLIA NUMBER - WALGREEN'S #10197

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Laboratory Demographics

CLIA Number: 13D2033514

Facility Name: WALGREEN'S #10197

Facility Address:
3150 W CHERRY LANE
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 319-2312

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1962575241

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	13D2033514
LAB Type	Pharmacy
Facility Name	WALGREEN'S #10197
Street	3150 W CHERRY LANE
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 319-2312
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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