13D2034366 CLIA NUMBER - WALGREEN'S #12503

Laboratory Demographics

  • CLIA Code: 13D2034366
  • Facility Name: WALGREEN'S #12503
  • Facility Address: 414 NORTH MAIN STREET
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 305-8119
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAE N. HODGE PHARMD
  • NPI Number: 1619490034
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Pharmacy
Lab Director RAE N. HODGE PHARMD

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