38D0991458 CLIA NUMBER - FRED MEYER PHARMACY #143

Laboratory Demographics

CLIA Number: 38D0991458

Facility Name: FRED MEYER PHARMACY #143

Facility Address:
6495 SE TUALATIN VALLEY HWY
HILLSBORO, OR
ZIP 97123
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Facility Phone Number: 503 848-4583

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1700821196

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	38D0991458
LAB Type	Pharmacy
Facility Name	FRED MEYER PHARMACY #143
Street	6495 SE TUALATIN VALLEY HWY
City	HILLSBORO
State	OR
ZIP	97123
Phone	503 848-4583
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