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38D0954420 CLIA NUMBER - FRED MEYER PHARMACY #393

Laboratory Demographics

CLIA Number: 38D0954420

Facility Name: FRED MEYER PHARMACY #393

Facility Address:
19200 SW MARTINAZZI AVE
TUALATIN, OR
ZIP 97062
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Facility Phone Number: 503 691-4233

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1831132042

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 38D0954420
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #393
Street 19200 SW MARTINAZZI AVE
City TUALATIN
State OR
ZIP 97062
Phone 503 691-4233
CertificateType 4
CertificateEffectiveDate 1/1/2024
CertificateExpirationDate 12/31/2025
FacilityType Waiver

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