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13D2216647 CLIA NUMBER - IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY#17284

Laboratory Demographics

CLIA Number: 13D2216647

Facility Name: IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY#17284

Facility Address:
16300 N MARKET PLACE BLVD
NAMPA, ID
ZIP 83687
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1336249648

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 13D2216647
LAB Type Pharmacy
Facility Name IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY#17284
Street 16300 N MARKET PLACE BLVD
City NAMPA
State ID
ZIP 83687
Phone 401 770-6431
CertificateType 4
CertificateEffectiveDate 3/15/2023
CertificateExpirationDate 3/14/2025
FacilityType Waiver

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