38D0971563 CLIA NUMBER - FRED MEYER PHARMACY #196

Laboratory Demographics

  • CLIA Code: 38D0971563
  • Facility Name: FRED MEYER PHARMACY #196
  • Facility Address: 1301 CENTER DRIVE
    MEDFORD, OR
    ZIP 97501
  • Facility Phone: 541 857-4683
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA HENSLEY
  • NPI Number: 1174568562
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0971563
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #196
Street 1301 CENTER DRIVE
City MEDFORD
State OR
ZIP 97501
Phone 541 857-4683
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 KAYLA HENSLEY

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