50D2090487 CLIA NUMBER - KELLEY-ROSS PHARMACY AT THE POLYCLINIC

Laboratory Demographics

  • CLIA Code: 50D2090487
  • Facility Name: KELLEY-ROSS PHARMACY AT THE POLYCLINIC
  • Facility Address: 904 7TH AVE # 103
    SEATTLE, WA
    ZIP 98104
  • Facility Phone: (206) 324-6990
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT HERZOG
  • NPI Number: 1669517025
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 50D2090487
LAB Type Pharmacy
Facility Name KELLEY-ROSS PHARMACY AT THE POLYCLINIC
Street 904 7TH AVE # 103
City SEATTLE
State WA
ZIP 98104
Phone 2063246990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2015
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SCOTT HERZOG

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 5/18/2026