13D2080861 CLIA NUMBER - WHITE CROSS PHARMACY

Laboratory Demographics

  • CLIA Code: 13D2080861
  • Facility Name: WHITE CROSS PHARMACY
  • Facility Address: 31964 N FIFTH AVE
    SPIRIT LAKE, ID
    ZIP 83869
  • Facility Phone: 208 623-8485
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICHARD DEBLAQUIERE
  • NPI Number: 1477973832
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2080861
LAB Type Pharmacy
Facility Name WHITE CROSS PHARMACY
Street 31964 N FIFTH AVE
City SPIRIT LAKE
State ID
ZIP 83869
Phone 208 623-8485
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/16/2024
Certificate Expiration Date 7/15/2026
Facility Type Pharmacy
Lab Director RICHARD DEBLAQUIERE

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