38D0991460 CLIA NUMBER - FRED MEYER PHARMACY #075

Laboratory Demographics

  • CLIA Code: 38D0991460
  • Facility Name: FRED MEYER PHARMACY #075
  • Facility Address: 14700 SE DIVISION
    PORTLAND, OR
    ZIP 97236
  • Facility Phone: 503 762-4436
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WASSIM AYOUB
  • NPI Number: 1093750168
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0991460
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #075
Street 14700 SE DIVISION
City PORTLAND
State OR
ZIP 97236
Phone 503 762-4436
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/20/2025
Certificate Expiration Date 9/19/2027
Facility Type Pharmacy
Lab Director WASSIM AYOUB

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