50D1023421 CLIA NUMBER - FRED MEYER PHARMACY #665

Laboratory Demographics

CLIA Number: 50D1023421

Facility Name: FRED MEYER PHARMACY #665

Facility Address:
1201 VALLEY AVE E
SUMNER, WA
ZIP 98390
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Facility Phone Number: 253 826-8433

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477931947

Taxonomy: 261QC1500X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	3/16/2004
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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This page was last updated on: 4/23/2024