13D2136415 CLIA NUMBER - BROULIMS PHARMACY #6

Laboratory Demographics

CLIA Number: 13D2136415

Facility Name: BROULIMS PHARMACY #6

Facility Address:
124 WEST MAIN ST
REXBURG, ID
ZIP 83440
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Facility Phone Number: 208 356-5416

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1003969346

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	13D2136415
LAB Type	Pharmacy
Facility Name	BROULIMS PHARMACY #6
Street	124 WEST MAIN ST
City	REXBURG
State	ID
ZIP	83440
Phone	208 356-5416
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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