13D2034289 CLIA NUMBER - WALGREENS #9918

Laboratory Demographics

  • CLIA Code: 13D2034289
  • Facility Name: WALGREENS #9918
  • Facility Address: 164 E MAIN ST
    REXBURG, ID
    ZIP 83440
  • Facility Phone: 208 227-5076
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDI E. SLACHTER PHARMD
  • NPI Number: 1043316425
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2034289
LAB Type Pharmacy
Facility Name WALGREENS #9918
Street 164 E MAIN ST
City REXBURG
State ID
ZIP 83440
Phone 208 227-5076
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Pharmacy
Lab Director BRANDI E. SLACHTER PHARMD

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