38D0971565 CLIA NUMBER - FRED MEYER PHARMACY #063

Laboratory Demographics

  • CLIA Code: 38D0971565
  • Facility Name: FRED MEYER PHARMACY #063
  • Facility Address: 16301 SE 82ND DRIVE
    CLACKAMAS, OR
    ZIP 97015
  • Facility Phone: 503 359-3103
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. BRIAN M. ZACHER
  • NPI Number: 1194751826
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0971565
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #063
Street 16301 SE 82ND DRIVE
City CLACKAMAS
State OR
ZIP 97015
Phone 503 359-3103
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 MR. BRIAN M. ZACHER

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