13D2033575 CLIA NUMBER - WALGREEN'S #10672

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Laboratory Demographics

CLIA Number: 13D2033575

Facility Name: WALGREEN'S #10672

Facility Address:
2219 12TH AVENUE RD
NAMPA, ID
ZIP 83686
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Facility Phone Number: 208 318-0536

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1386839678

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	13D2033575
LAB Type	Pharmacy
Facility Name	WALGREEN'S #10672
Street	2219 12TH AVENUE RD
City	NAMPA
State	ID
ZIP	83686
Phone	208 318-0536
CertificateType	4
CertificateEffectiveDate	3/15/2023
CertificateExpirationDate	3/14/2025
FacilityType	Waiver

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