13D2203950 CLIA NUMBER - SALMON PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 13D2203950
  • Facility Name: SALMON PHARMACY LLC
  • Facility Address: 309 MAIN ST
    SALMON, ID
    ZIP 83467
  • Facility Phone: 208 742-3784
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL CONGER PHARMD
  • NPI Number: 1013540814
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2203950
LAB Type Pharmacy
Facility Name SALMON PHARMACY LLC
Street 309 MAIN ST
City SALMON
State ID
ZIP 83467
Phone 208 742-3784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2024
Certificate Expiration Date 12/6/2026
Facility Type Pharmacy
Lab Director MICHAEL CONGER PHARMD

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