50D1023421 CLIA NUMBER - FRED MEYER PHARMACY #665

Laboratory Demographics

  • CLIA Code: 50D1023421
  • Facility Name: FRED MEYER PHARMACY #665
  • Facility Address: 1201 VALLEY AVE E
    SUMNER, WA
    ZIP 98390
  • Facility Phone: 253 826-8433
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMES KILGUS
  • NPI Number: 1477931947
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 50D1023421
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #665
Street 1201 VALLEY AVE E
City SUMNER
State WA
ZIP 98390
Phone 253 826-8433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2004
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director JAMES KILGUS

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