13D2154433 CLIA NUMBER - MIKE'S PHARMACY

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CLIA Record

Field Name Field Value
CLIA Number 13D2154433
LAB Type Pharmacy
Facility Name MIKE'S PHARMACY
Street 180 SO HOLMES AVE
City IDAHO FALLS
State ID
ZIP 83401
Phone 208 525-8700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Pharmacy
Lab Director MICHAEL D. MERRILL PHARMACIST

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