13D2034370 CLIA NUMBER - WALGREENS #10314

Laboratory Demographics

  • CLIA Code: 13D2034370
  • Facility Name: WALGREENS #10314
  • Facility Address: 260 W HONEYSUCKLE AVENUE
    HAYDEN, ID
    ZIP 83835
  • Facility Phone: 208 762-0185
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEY M. OTIS
  • NPI Number: 1992935696
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2034370
LAB Type Pharmacy
Facility Name WALGREENS #10314
Street 260 W HONEYSUCKLE AVENUE
City HAYDEN
State ID
ZIP 83835
Phone 208 762-0185
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 ASHLEY M. OTIS

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