13D2052423 CLIA NUMBER - WALGREENS 13888

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Laboratory Demographics

CLIA Number: 13D2052423

Facility Name: WALGREENS 13888

Facility Address:
455 S BROADWAY AVENUE
BOISE, ID
ZIP 83702
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Facility Phone Number: 208 331-4187

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1447508387

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	13D2052423
LAB Type	Pharmacy
Facility Name	WALGREENS 13888
Street	455 S BROADWAY AVENUE
City	BOISE
State	ID
ZIP	83702
Phone	208 331-4187
CertificateType	4
CertificateEffectiveDate	9/14/2023
CertificateExpirationDate	9/13/2025
FacilityType	Waiver

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