50D2281860 CLIA NUMBER - EVERGREEN DERMATOPATHOLOGY

Laboratory Demographics

  • CLIA Code: 50D2281860
  • Facility Name: EVERGREEN DERMATOPATHOLOGY
  • Facility Address: 2110 N MOLTER RD STE 112
    LIBERTY LAKE, WA
    ZIP 99019
  • Facility Phone: 208 277-9704
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: ASHLEY HAMSTRA
  • NPI Number: 1700581170
  • Taxonomy: 207ZD0900X - Pathology

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CLIA Record

Field Name Field Value
CLIA Number 50D2281860
LAB Type Independent
Facility Name EVERGREEN DERMATOPATHOLOGY
Street 2110 N MOLTER RD STE 112
City LIBERTY LAKE
State WA
ZIP 99019
Phone 208 277-9704
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/12/2023
Certificate Expiration Date 4/4/2028
Facility Type Independent
Lab Director ASHLEY HAMSTRA

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