38D0971540 CLIA NUMBER - FRED MEYER PHARMACY #030

Laboratory Demographics

  • CLIA Code: 38D0971540
  • Facility Name: FRED MEYER PHARMACY #030
  • Facility Address: 325 FIFTH STREET
    BROOKINGS, OR
    ZIP 97415
  • Facility Phone: 541 469-1643
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON THORESON
  • NPI Number: 1083659478
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0971540
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #030
Street 325 FIFTH STREET
City BROOKINGS
State OR
ZIP 97415
Phone 541 469-1643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2024
Certificate Expiration Date 3/14/2026
Facility Type Pharmacy
Lab Director BRANDON THORESON

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