50D0961174 CLIA NUMBER - FRED MEYER PHARMACY #208

Laboratory Demographics

  • CLIA Code: 50D0961174
  • Facility Name: FRED MEYER PHARMACY #208
  • Facility Address: 11325 SE MILL PLAIN BLVD
    VANCOUVER, WA
    ZIP 98684
  • Facility Phone: 360 256-4406
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATT MCCARTY
  • NPI Number: 1215973755
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0961174
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #208
Street 11325 SE MILL PLAIN BLVD
City VANCOUVER
State WA
ZIP 98684
Phone 360 256-4406
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/1999
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director MATT MCCARTY

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