50D0975326 CLIA NUMBER - SAFEWAY PHARMACY #1611

Laboratory Demographics

  • CLIA Code: 50D0975326
  • Facility Name: SAFEWAY PHARMACY #1611
  • Facility Address: 6711 NE 63RD ST
    VANCOUVER, WA
    ZIP 98661
  • Facility Phone: 360 992-5686
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN TEGART
  • NPI Number: 1013948819
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0975326
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1611
Street 6711 NE 63RD ST
City VANCOUVER
State WA
ZIP 98661
Phone 360 992-5686
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/5/2000
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