13D2033646 CLIA NUMBER - WALGREEN'S #05648

Laboratory Demographics

  • CLIA Code: 13D2033646
  • Facility Name: WALGREEN'S #05648
  • Facility Address: 700 12TH AVENUE S
    NAMPA, ID
    ZIP 83651
  • Facility Phone: 208 467-1560
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN P. THUESON
  • NPI Number: 1417962531
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Pharmacy
Lab Director RYAN P. THUESON

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