13D2034367 CLIA NUMBER - WALGREEN'S #06863

Laboratory Demographics

  • CLIA Code: 13D2034367
  • Facility Name: WALGREEN'S #06863
  • Facility Address: 335 W APPLEWAY AVE
    COEUR D'ALENE, ID
    ZIP 83814
  • Facility Phone: 208 765-1254
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER A. MITCHELL
  • NPI Number: 1962417089
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2034367
LAB Type Pharmacy
Facility Name WALGREEN'S #06863
Street 335 W APPLEWAY AVE
City COEUR D'ALENE
State ID
ZIP 83814
Phone 208 765-1254
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Pharmacy
Lab Director JENNIFER A. MITCHELL

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