13D2033562 CLIA NUMBER - WALGREEN'S 12124

Laboratory Demographics

  • CLIA Code: 13D2033562
  • Facility Name: WALGREEN'S 12124
  • Facility Address: 265 S EAGLE ROAD
    EAGLE, ID
    ZIP 83616
  • Facility Phone: 208 319-0543
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARAH A. TARANTINO
  • NPI Number: 1326358904
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2033562
LAB Type Pharmacy
Facility Name WALGREEN'S 12124
Street 265 S EAGLE ROAD
City EAGLE
State ID
ZIP 83616
Phone 208 319-0543
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Pharmacy
Lab Director SARAH A. TARANTINO

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