38D0971538 CLIA NUMBER - FRED MEYER PHARMACY #375

Laboratory Demographics

CLIA Number: 38D0971538

Facility Name: FRED MEYER PHARMACY #375

Facility Address:
11565 SW PACIFIC HIGHWAY
TIGARD, OR
ZIP 97223
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Facility Phone Number: 503 293-7085

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1083081905

Taxonomy: 261QP0905X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0971538
LAB Type	Pharmacy
Facility Name	FRED MEYER PHARMACY #375
Street	11565 SW PACIFIC HIGHWAY
City	TIGARD
State	OR
ZIP	97223
Phone	503 293-7085
CertificateType	4
CertificateEffectiveDate	3/15/2024
CertificateExpirationDate	3/14/2026
FacilityType	Waiver

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