13D2034635 CLIA NUMBER - WALGREENS #04942

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Laboratory Demographics

CLIA Number: 13D2034635

Facility Name: WALGREENS #04942

Facility Address:
8100 W FAIRVIEW AVE
BOISE, ID
ZIP 83704
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Facility Phone Number: 208 375-2825

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1881609907

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	13D2034635
LAB Type	Pharmacy
Facility Name	WALGREENS #04942
Street	8100 W FAIRVIEW AVE
City	BOISE
State	ID
ZIP	83704
Phone	208 375-2825
CertificateType	4
CertificateEffectiveDate	2/23/2023
CertificateExpirationDate	2/22/2025
FacilityType	Waiver

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