13D2033704 CLIA NUMBER - WALGREEN'S #11541

Laboratory Demographics

  • CLIA Code: 13D2033704
  • Facility Name: WALGREEN'S #11541
  • Facility Address: 4110 S 10TH AVE
    CALDWELL, ID
    ZIP 83605
  • Facility Phone: 208 402-0154
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN A. PETERSON
  • NPI Number: 1902087794
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2033704
LAB Type Pharmacy
Facility Name WALGREEN'S #11541
Street 4110 S 10TH AVE
City CALDWELL
State ID
ZIP 83605
Phone 208 402-0154
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director RYAN A. PETERSON

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