38D1059192 CLIA NUMBER - SAFEWAY PHARMACY #1047

Laboratory Demographics

  • CLIA Code: 38D1059192
  • Facility Name: SAFEWAY PHARMACY #1047
  • Facility Address: 17779 LOWER BOONES FERRY RD
    LAKE OSWEGO, OR
    ZIP 97035
  • Facility Phone: 503 675-2509
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SOPHORN LIM
  • NPI Number: 1144266917
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D1059192
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1047
Street 17779 LOWER BOONES FERRY RD
City LAKE OSWEGO
State OR
ZIP 97035
Phone 503 675-2509
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2024
Certificate Expiration Date 9/24/2026
Facility Type Pharmacy
Lab Director SOPHORN LIM

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