50D0965259 CLIA NUMBER - FRED MEYER PHARMACY #615

Laboratory Demographics

  • CLIA Code: 50D0965259
  • Facility Name: FRED MEYER PHARMACY #615
  • Facility Address: 6305 BRIDGEPORT WAY W
    UNIVERSITY PLACE, WA
    ZIP 98467
  • Facility Phone: 253 460-4033
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM THU VU
  • NPI Number: 1558307199
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0965259
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #615
Street 6305 BRIDGEPORT WAY W
City UNIVERSITY PLACE
State WA
ZIP 98467
Phone 253 460-4033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/1999
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director KIM THU VU

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