50D0968896 CLIA NUMBER - FRED MEYER PHARMACY #41

Laboratory Demographics

  • CLIA Code: 50D0968896
  • Facility Name: FRED MEYER PHARMACY #41
  • Facility Address: 20904 HIGHWAY 410
    BONNEY LAKE, WA
    ZIP 98390
  • Facility Phone: 253 891-7333
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN TIEDEMAN
  • NPI Number: 1790711489
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0968896
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #41
Street 20904 HIGHWAY 410
City BONNEY LAKE
State WA
ZIP 98390
Phone 253 891-7333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/1999
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director RYAN TIEDEMAN

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