13D2187712 CLIA NUMBER - MEDICAP PHARMACY #8427

Laboratory Demographics

CLIA Number: 13D2187712

Facility Name: MEDICAP PHARMACY #8427

Facility Address:
284 VILLAGE CIRCLE STE #100
GARDEN VALLEY, ID
ZIP 83622
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Facility Phone Number: 208 901-8006

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457874612

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	13D2187712
LAB Type	Pharmacy
Facility Name	MEDICAP PHARMACY #8427
Street	284 VILLAGE CIRCLE STE #100
City	GARDEN VALLEY
State	ID
ZIP	83622
Phone	208 901-8006
CertificateType	4
CertificateEffectiveDate	7/7/2022
CertificateExpirationDate	7/6/2024
FacilityType	Waiver

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