13D2092088 CLIA NUMBER - RITE AID PHARMACY #5413

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Laboratory Demographics

CLIA Number: 13D2092088

Facility Name: RITE AID PHARMACY #5413

Facility Address:
1515 W STATE ST
BOISE, ID
ZIP 83702
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Facility Phone Number: 208 345-7684

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1164438461

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	13D2092088
LAB Type	Pharmacy
Facility Name	RITE AID PHARMACY #5413
Street	1515 W STATE ST
City	BOISE
State	ID
ZIP	83702
Phone	208 345-7684
CertificateType	4
CertificateEffectiveDate	2/26/2023
CertificateExpirationDate	2/25/2025
FacilityType	Waiver

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