38D0971557 CLIA NUMBER - FRED MEYER PHARMACY #125

Laboratory Demographics

  • CLIA Code: 38D0971557
  • Facility Name: FRED MEYER PHARMACY #125
  • Facility Address: 6615 NE GLISAN STREET
    PORTLAND, OR
    ZIP 97213
  • Facility Phone: 503 797-6973
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WASSIM AYOUB
  • NPI Number: 1386680296
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 38D0971557
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #125
Street 6615 NE GLISAN STREET
City PORTLAND
State OR
ZIP 97213
Phone 503 797-6973
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2024
Certificate Expiration Date 3/15/2026
Facility Type Pharmacy
Lab Director WASSIM AYOUB

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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