13D2033517 CLIA NUMBER - WALGREENS #11687

Laboratory Demographics

  • CLIA Code: 13D2033517
  • Facility Name: WALGREENS #11687
  • Facility Address: 4850 N LINDER ROAD
    MERIDIAN, ID
    ZIP 83646
  • Facility Phone: 208 319-0047
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WALTER MATHIS
  • NPI Number: 1093953218
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2033517
LAB Type Pharmacy
Facility Name WALGREENS #11687
Street 4850 N LINDER ROAD
City MERIDIAN
State ID
ZIP 83646
Phone 208 319-0047
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 WALTER MATHIS

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This page was last updated on: 6/4/2025