50D0964315 CLIA NUMBER - FRED MEYER PHARMACY #390

Laboratory Demographics

  • CLIA Code: 50D0964315
  • Facility Name: FRED MEYER PHARMACY #390
  • Facility Address: 4505 S 19TH ST
    TACOMA, WA
    ZIP 98405
  • Facility Phone: 253 752-9110
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN WARREN
  • NPI Number: 1891030300
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D0964315
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #390
Street 4505 S 19TH ST
City TACOMA
State WA
ZIP 98405
Phone 253 752-9110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/1999
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director KEVIN WARREN

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