38D0909459 CLIA NUMBER - FRED MEYER PHARMACY #135

Laboratory Demographics

  • CLIA Code: 38D0909459
  • Facility Name: FRED MEYER PHARMACY #135
  • Facility Address: 3805 SE HAWTHORNE BLVD
    PORTLAND, OR
    ZIP 97214
  • Facility Phone: 503 234-7559
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IAN WOOD
  • NPI Number: 1902841075
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0909459
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #135
Street 3805 SE HAWTHORNE BLVD
City PORTLAND
State OR
ZIP 97214
Phone 503 234-7559
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Pharmacy
Lab Director IAN WOOD

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