38D1001341 CLIA NUMBER - FRED MEYER PHARMACY #150

Laboratory Demographics

  • CLIA Code: 38D1001341
  • Facility Name: FRED MEYER PHARMACY #150
  • Facility Address: 7404 N INTERSTATE AVE
    PORTLAND, OR
    ZIP 97217
  • Facility Phone: 503 286-6784
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON THORESON
  • NPI Number: 1063897239
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D1001341
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #150
Street 7404 N INTERSTATE AVE
City PORTLAND
State OR
ZIP 97217
Phone 503 286-6784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Pharmacy
Lab Director BRANDON THORESON

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