13D2052423 CLIA NUMBER - WALGREENS 13888

Laboratory Demographics

  • CLIA Code: 13D2052423
  • Facility Name: WALGREENS 13888
  • Facility Address: 455 S BROADWAY AVENUE
    BOISE, ID
    ZIP 83702
  • Facility Phone: 208 331-4187
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JILU D. VARUGHESE
  • NPI Number: 1447508387
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2052423
LAB Type Pharmacy
Facility Name WALGREENS 13888
Street 455 S BROADWAY AVENUE
City BOISE
State ID
ZIP 83702
Phone 208 331-4187
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2025
Certificate Expiration Date 9/13/2027
Facility Type Pharmacy
Lab Director JILU D. VARUGHESE

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