13D2149772 CLIA NUMBER - IDAHO STATE UNIVERSITY BENGAL PHARMACY

Laboratory Demographics

  • CLIA Code: 13D2149772
  • Facility Name: IDAHO STATE UNIVERSITY BENGAL PHARMACY
  • Facility Address: 990 SOUTH 8TH AVENUE
    POCATELLO, ID
    ZIP 83209
  • Facility Phone: 208 282-3407
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RIKKI TRUSSEL
  • NPI Number: 1376602680
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2149772
LAB Type Pharmacy
Facility Name IDAHO STATE UNIVERSITY BENGAL PHARMACY
Street 990 SOUTH 8TH AVENUE
City POCATELLO
State ID
ZIP 83209
Phone 208 282-3407
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Pharmacy
Lab Director RIKKI TRUSSEL

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