50D2175505 CLIA NUMBER - OTHELLO STATION PHARMACY

Laboratory Demographics

  • CLIA Code: 50D2175505
  • Facility Name: OTHELLO STATION PHARMACY
  • Facility Address: 4219 S OTHELLO ST # 105F
    SEATTLE, WA
    ZIP 98118
  • Facility Phone: 206 620-2400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AHMED ALI
  • NPI Number: 1841705886
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2175505
LAB Type Pharmacy
Facility Name OTHELLO STATION PHARMACY
Street 4219 S OTHELLO ST # 105F
City SEATTLE
State WA
ZIP 98118
Phone 206 620-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2019
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director AHMED ALI

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