13D2033646 CLIA NUMBER - WALGREEN'S #05648

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Laboratory Demographics

CLIA Number: 13D2033646

Facility Name: WALGREEN'S #05648

Facility Address:
700 12TH AVENUE S
NAMPA, ID
ZIP 83651
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Facility Phone Number: 208 467-1560

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1417962531

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	13D2033646
LAB Type	Pharmacy
Facility Name	WALGREEN'S #05648
Street	700 12TH AVENUE S
City	NAMPA
State	ID
ZIP	83651
Phone	208 467-1560
CertificateType	4
CertificateEffectiveDate	2/8/2023
CertificateExpirationDate	2/7/2025
FacilityType	Waiver

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