13D2210873 CLIA NUMBER - WHITE CROSS PHARMACY

Laboratory Demographics

  • CLIA Code: 13D2210873
  • Facility Name: WHITE CROSS PHARMACY
  • Facility Address: 86 TANK RD
    OLDTOWN, ID
    ZIP 83822
  • Facility Phone: 208 457-7160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICHARD A. DE BLAQUIERE PHARMD
  • NPI Number: 1841806494
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2210873
LAB Type Pharmacy
Facility Name WHITE CROSS PHARMACY
Street 86 TANK RD
City OLDTOWN
State ID
ZIP 83822
Phone 208 457-7160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Pharmacy
Lab Director RICHARD A. DE BLAQUIERE PHARMD

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