13D2033517 CLIA NUMBER - WALGREENS #11687

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Laboratory Demographics

CLIA Number: 13D2033517

Facility Name: WALGREENS #11687

Facility Address:
4850 N LINDER ROAD
MERIDIAN, ID
ZIP 83646
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Facility Phone Number: 208 319-0047

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093953218

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