38D1102681 CLIA NUMBER - FRED MEYER PHARMACY #165

Laboratory Demographics

  • CLIA Code: 38D1102681
  • Facility Name: FRED MEYER PHARMACY #165
  • Facility Address: 2655 SHASTA WAY
    KLAMATH FALLS, OR
    ZIP 97603
  • Facility Phone: 541 884-1780
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON THORESON
  • NPI Number: 1629013016
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D1102681
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #165
Street 2655 SHASTA WAY
City KLAMATH FALLS
State OR
ZIP 97603
Phone 541 884-1780
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2025
Certificate Expiration Date 7/21/2027
Facility Type Pharmacy
Lab Director BRANDON THORESON

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