13D2140172 CLIA NUMBER - BEAR LAKE DRUG LLC

Laboratory Demographics

  • CLIA Code: 13D2140172
  • Facility Name: BEAR LAKE DRUG LLC
  • Facility Address: 836 WASHINGTON ST
    MONTPELIER, ID
    ZIP 83254
  • Facility Phone: 208 847-1421
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CASEY C. HUMPHERYS
  • NPI Number: 1861806820
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2140172
LAB Type Pharmacy
Facility Name BEAR LAKE DRUG LLC
Street 836 WASHINGTON ST
City MONTPELIER
State ID
ZIP 83254
Phone 208 847-1421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director CASEY C. HUMPHERYS

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