50D2050631 CLIA NUMBER - SAFEWAY PHARMACY 1624

Laboratory Demographics

  • CLIA Code: 50D2050631
  • Facility Name: SAFEWAY PHARMACY 1624
  • Facility Address: 735 NW GILMAN BLVD
    ISSAQUAH, WA
    ZIP 98027
  • Facility Phone: 425 507-1042
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN M. TEGART
  • NPI Number: 1396911343
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2050631
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY 1624
Street 735 NW GILMAN BLVD
City ISSAQUAH
State WA
ZIP 98027
Phone 425 507-1042
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2012
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SUSAN M. TEGART

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