50D0961175 CLIA NUMBER - FRED MEYER PHARMACY #460

Laboratory Demographics

  • CLIA Code: 50D0961175
  • Facility Name: FRED MEYER PHARMACY #460
  • Facility Address: 800 NE TENNEY RD
    VANCOUVER, WA
    ZIP 98685
  • Facility Phone: 360 571-2573
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIANA DEVORE
  • NPI Number: 1912943556
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 50D0961175
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #460
Street 800 NE TENNEY RD
City VANCOUVER
State WA
ZIP 98685
Phone 360 571-2573
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 DIANA DEVORE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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