13D2150657 CLIA NUMBER - CHATEAU DRUG

Laboratory Demographics

  • CLIA Code: 13D2150657
  • Facility Name: CHATEAU DRUG
  • Facility Address: 451 4TH ST
    KETCHUM, ID
    ZIP 83340
  • Facility Phone: 208 726-2596
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SEBASTIAN GREGORIO PHARMACIST
  • NPI Number: 1912073552
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2150657
LAB Type Pharmacy
Facility Name CHATEAU DRUG
Street 451 4TH ST
City KETCHUM
State ID
ZIP 83340
Phone 208 726-2596
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Pharmacy
Lab Director SEBASTIAN GREGORIO PHARMACIST

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