13D2183315 CLIA NUMBER - CUSTOM RX PHARMACY

Laboratory Demographics

  • CLIA Code: 13D2183315
  • Facility Name: CUSTOM RX PHARMACY
  • Facility Address: 173 W 4TH STREET
    KUNA, ID
    ZIP 83634
  • Facility Phone: 208 922-4400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC B. SCHLERF
  • NPI Number: 1457682114
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2183315
LAB Type Pharmacy
Facility Name CUSTOM RX PHARMACY
Street 173 W 4TH STREET
City KUNA
State ID
ZIP 83634
Phone 208 922-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2024
Certificate Expiration Date 5/3/2026
Facility Type Pharmacy
Lab Director ERIC B. SCHLERF

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