50D0969330 CLIA NUMBER - SAFEWAY PHARMACY #4405

Laboratory Demographics

  • CLIA Code: 50D0969330
  • Facility Name: SAFEWAY PHARMACY #4405
  • Facility Address: 408 NE 81ST ST
    VANCOUVER, WA
    ZIP 98665
  • Facility Phone: 360 574-8824
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN TEGART
  • NPI Number: 1972549574
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0969330
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #4405
Street 408 NE 81ST ST
City VANCOUVER
State WA
ZIP 98665
Phone 360 574-8824
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2000
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SUSAN TEGART

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