13D2158548 CLIA NUMBER - MAAG PRESCRIPTION CENTER LLC

Laboratory Demographics

CLIA Number: 13D2158548

Facility Name: MAAG PRESCRIPTION CENTER LLC

Facility Address:
333 W CENTER ST
POCATELLO, ID
ZIP 83204
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Facility Phone Number: 208 233-2063

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1134783202

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	13D2158548
LAB Type	Pharmacy
Facility Name	MAAG PRESCRIPTION CENTER LLC
Street	333 W CENTER ST
City	POCATELLO
State	ID
ZIP	83204
Phone	208 233-2063
CertificateType	4
CertificateEffectiveDate	11/30/2022
CertificateExpirationDate	11/29/2024
FacilityType	Waiver

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