38D2081030 CLIA NUMBER - SAFEWAY PHARMACY #1612

Laboratory Demographics

  • CLIA Code: 38D2081030
  • Facility Name: SAFEWAY PHARMACY #1612
  • Facility Address: 1100 NE BROADWAY ST
    PORTLAND, OR
    ZIP 97232
  • Facility Phone: (503) 528-0506
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMBER PORTNER
  • NPI Number: 1932138971
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2081030
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1612
Street 1100 NE BROADWAY ST
City PORTLAND
State OR
ZIP 97232
Phone 5035280506
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type Pharmacy
Lab Director AMBER PORTNER

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This page was last updated on: 5/15/2026