50D0966742 CLIA NUMBER - FRED MEYER PHARMACY #122

Laboratory Demographics

  • CLIA Code: 50D0966742
  • Facility Name: FRED MEYER PHARMACY #122
  • Facility Address: 100 NW 85TH ST
    SEATTLE, WA
    ZIP 98117
  • Facility Phone: 206 783-2272
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SEAN TOLSTEDT
  • NPI Number: 1477596682
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0966742
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #122
Street 100 NW 85TH ST
City SEATTLE
State WA
ZIP 98117
Phone 206 783-2272
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/1999
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SEAN TOLSTEDT

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