38D0971556 CLIA NUMBER - FRED MEYER PHARMACY #128

Laboratory Demographics

CLIA Number: 38D0971556

Facility Name: FRED MEYER PHARMACY #128

Facility Address:
1111 NE 102ND
PORTLAND, OR
ZIP 97220
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Facility Phone Number: 503 255-5494

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1720023898

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	38D0971556
LAB Type	Pharmacy
Facility Name	FRED MEYER PHARMACY #128
Street	1111 NE 102ND
City	PORTLAND
State	OR
ZIP	97220
Phone	503 255-5494
CertificateType	4
CertificateEffectiveDate	3/16/2024
CertificateExpirationDate	3/15/2026
FacilityType	Waiver

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