38D0996100 CLIA NUMBER - FRED MEYER PHARMACY #360

Laboratory Demographics

  • CLIA Code: 38D0996100
  • Facility Name: FRED MEYER PHARMACY #360
  • Facility Address: 100 NW 20TH PLACE
    PORTLAND, OR
    ZIP 97209
  • Facility Phone: 503 226-7179
  • Facility Type: Health Fair
  • Facility Type: Waiver
  • Lab Director: MS. STEPHANIE GASTON
  • NPI Number: 1336185297
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D0996100
LAB Type Health Fair
Facility Name FRED MEYER PHARMACY #360
Street 100 NW 20TH PLACE
City PORTLAND
State OR
ZIP 97209
Phone 503 226-7179
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2024
Certificate Expiration Date 2/7/2026
Facility Type Health Fair
Lab Director MS. STEPHANIE GASTON

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