13D2034366 CLIA NUMBER - WALGREEN'S #12503

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Laboratory Demographics

CLIA Number: 13D2034366

Facility Name: WALGREEN'S #12503

Facility Address:
414 NORTH MAIN STREET
MOSCOW, ID
ZIP 83843
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Facility Phone Number: 208 305-8119

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1619490034

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	13D2034366
LAB Type	Pharmacy
Facility Name	WALGREEN'S #12503
Street	414 NORTH MAIN STREET
City	MOSCOW
State	ID
ZIP	83843
Phone	208 305-8119
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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