38D2025203 CLIA NUMBER - FRED MEYER PHARMACY #516

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Laboratory Demographics

CLIA Number: 38D2025203

Facility Name: FRED MEYER PHARMACY #516

Facility Address:
30300 SW BOONES FERRY RD
WILSONVILLE, OR
ZIP 97070
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Facility Phone Number: 503 570-3533

Facility Type: Health Fair

Certificate Type: Waiver

NPI Number: 1750676441

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	38D2025203
LAB Type	Health Fair
Facility Name	FRED MEYER PHARMACY #516
Street	30300 SW BOONES FERRY RD
City	WILSONVILLE
State	OR
ZIP	97070
Phone	503 570-3533
CertificateType	4
CertificateEffectiveDate	6/3/2023
CertificateExpirationDate	6/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024