13D2210868 CLIA NUMBER - RATHDRUM DRUG

Laboratory Demographics

CLIA Number: 13D2210868

Facility Name: RATHDRUM DRUG

Facility Address:
16438 N HWY 41
RATHDRUM, ID
ZIP 83858
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Facility Phone Number: 208 687-0731

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1881194090

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	13D2210868
LAB Type	Pharmacy
Facility Name	RATHDRUM DRUG
Street	16438 N HWY 41
City	RATHDRUM
State	ID
ZIP	83858
Phone	208 687-0731
CertificateType	4
CertificateEffectiveDate	1/25/2023
CertificateExpirationDate	1/24/2025
FacilityType	Waiver

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