13D2034134 CLIA NUMBER - WALGREEN'S #06380

Laboratory Demographics

  • CLIA Code: 13D2034134
  • Facility Name: WALGREEN'S #06380
  • Facility Address: 905 YELLOWSTONE AVE
    POCATELLO, ID
    ZIP 83201
  • Facility Phone: 208 233-2382
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. WATSON
  • NPI Number: 1144235268
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2034134
LAB Type Pharmacy
Facility Name WALGREEN'S #06380
Street 905 YELLOWSTONE AVE
City POCATELLO
State ID
ZIP 83201
Phone 208 233-2382
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Pharmacy
Lab Director MICHAEL J. WATSON

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