50D0974173 CLIA NUMBER - FRED MEYER PHARMACY #457

Laboratory Demographics

  • CLIA Code: 50D0974173
  • Facility Name: FRED MEYER PHARMACY #457
  • Facility Address: 21045 BOTHELL-EVERETT HWY
    BOTHELL, WA
    ZIP 98021
  • Facility Phone: 425 398-7033
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DINAKAR TATINENI
  • NPI Number: 1649216284
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0974173
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #457
Street 21045 BOTHELL-EVERETT HWY
City BOTHELL
State WA
ZIP 98021
Phone 425 398-7033
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 DINAKAR TATINENI

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