50D0974172 CLIA NUMBER - FRED MEYER PHARMACY #458

Laboratory Demographics

  • CLIA Code: 50D0974172
  • Facility Name: FRED MEYER PHARMACY #458
  • Facility Address: 12906 BOTHELL EVERETT HWY
    MILL CREEK, WA
    ZIP 98012
  • Facility Phone: 425 357-2033
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER WORTHINGTON
  • NPI Number: 1497791834
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0974172
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #458
Street 12906 BOTHELL EVERETT HWY
City MILL CREEK
State WA
ZIP 98012
Phone 425 357-2033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2000
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director TYLER WORTHINGTON

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