38D2315753 CLIA NUMBER - PROCARE PHARMACY LLC DBA CVS SPECIALTY PHARMACY 2819

Laboratory Demographics

  • CLIA Code: 38D2315753
  • Facility Name: PROCARE PHARMACY LLC DBA CVS SPECIALTY PHARMACY 2819
  • Facility Address: 1309 NW 23RD AVE
    PORTLAND, OR
    ZIP 97210
  • Facility Phone: 503 295-7941
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON W. BOESHANS
  • NPI Number: 1558470039
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 38D2315753
LAB Type Pharmacy
Facility Name PROCARE PHARMACY LLC DBA CVS SPECIALTY PHARMACY 2819
Street 1309 NW 23RD AVE
City PORTLAND
State OR
ZIP 97210
Phone 503 295-7941
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Pharmacy
Lab Director JASON W. BOESHANS

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