50D0984315 CLIA NUMBER - FRED MEYER PHARMACY #00658

Laboratory Demographics

  • CLIA Code: 50D0984315
  • Facility Name: FRED MEYER PHARMACY #00658
  • Facility Address: 6100 EAST LAKE SAMMAMISH PARKWAY SE
    ISSAQUAH, WA
    ZIP 98029
  • Facility Phone: 425 416-1133
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LELE PHAM
  • NPI Number: 1467498006
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D0984315
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #00658
Street 6100 EAST LAKE SAMMAMISH PARKWAY SE
City ISSAQUAH
State WA
ZIP 98029
Phone 425 416-1133
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2001
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director LELE PHAM

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