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13D2099323 CLIA NUMBER - IDAHO STATE UNIVERSITY COLLEGE OF PHARMACY

Laboratory Demographics

CLIA Number: 13D2099323

Facility Name: IDAHO STATE UNIVERSITY COLLEGE OF PHARMACY

Facility Address:
970 S 5TH AVE
POCATELLO, ID
ZIP 83201
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Facility Phone Number: 208 221-0754

Facility Type: Health Fair

Certificate Type: Waiver
NPI Number: 1780032326

Taxonomy: 251S00000X - Community/Behavioral Health
A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

CLIA Record

Field Name Field Value
CLIA Number 13D2099323
LAB Type Health Fair
Facility Name IDAHO STATE UNIVERSITY COLLEGE OF PHARMACY
Street 970 S 5TH AVE
City POCATELLO
State ID
ZIP 83201
Phone 208 221-0754
CertificateType 4
CertificateEffectiveDate 7/24/2023
CertificateExpirationDate 7/23/2025
FacilityType Waiver

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