38D0991455 CLIA NUMBER - FRED MEYER PHARMACY #050

Laboratory Demographics

CLIA Number: 38D0991455

Facility Name: FRED MEYER PHARMACY #050

Facility Address:
1020 S FIRST AVE
COOS BAY, OR
ZIP 97420
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Facility Phone Number: 541 269-4033

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1023044237

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	38D0991455
LAB Type	Pharmacy
Facility Name	FRED MEYER PHARMACY #050
Street	1020 S FIRST AVE
City	COOS BAY
State	OR
ZIP	97420
Phone	541 269-4033
CertificateType	4
CertificateEffectiveDate	9/20/2023
CertificateExpirationDate	9/19/2025
FacilityType	Waiver

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