13D2217395 CLIA NUMBER - WALGREENS #15973

Laboratory Demographics

  • CLIA Code: 13D2217395
  • Facility Name: WALGREENS #15973
  • Facility Address: 1604 W BROADWAY ST
    IDAHO FALLS, ID
    ZIP 83402
  • Facility Phone: 208 522-4655
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHRYN C. HUNTER
  • NPI Number: 1093996399
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2217395
LAB Type Pharmacy
Facility Name WALGREENS #15973
Street 1604 W BROADWAY ST
City IDAHO FALLS
State ID
ZIP 83402
Phone 208 522-4655
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director KATHRYN C. HUNTER

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