13D2223587 CLIA NUMBER - IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY #16216

Laboratory Demographics

CLIA Number: 13D2223587

Facility Name: IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY #16216

Facility Address:
1611 BLUE LAKES BLVD N
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1841212636

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	13D2223587
LAB Type	Pharmacy
Facility Name	IDAHO CVS PHARMACY LLC DBA CVS/PHARMACY #16216
Street	1611 BLUE LAKES BLVD N
City	TWIN FALLS
State	ID
ZIP	83301
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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