13D2183424 CLIA NUMBER - JACK'S PHARMACY

Laboratory Demographics

  • CLIA Code: 13D2183424
  • Facility Name: JACK'S PHARMACY
  • Facility Address: 103 E COLLEGE AVE
    ST MARIES, ID
    ZIP 83861
  • Facility Phone: 208 245-4578
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLT T. DARLEY PHARMD
  • NPI Number: 1518967710
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2183424
LAB Type Pharmacy
Facility Name JACK'S PHARMACY
Street 103 E COLLEGE AVE
City ST MARIES
State ID
ZIP 83861
Phone 208 245-4578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Pharmacy
Lab Director COLT T. DARLEY PHARMD

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