CLIA lab
CLIA 13D2167140: Broulim's Pharmacy #17
Ammon, ID. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 13D2167140 belongs to Broulim's Pharmacy #17 in Ammon, ID.
Certificate of Waiver, effective June 3, 2025, expires June 2, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- June 3, 2025
- Certificate expiration
- June 2, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 3, 2019
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 13D2167140
- Lab name
- Broulim's Pharmacy #17
- Address
- 3160 E 17th St Ste 164, Ammon, ID 83406
- Phone
- (208) 529-1795
- Fax
- (208) 529-1838
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Ammon, ID
- Biolife Plasma Services LPCertificate of Compliance, Other13D1084280
- Broulims Pharmacy #8Certificate of Waiver, Pharmacy13D2140232
- Gameday Men's Health Idaho FallsCertificate of Accreditation, Physician office13D2320396
- Greater Good Health PC, IncCertificate of Waiver, Community clinic13D2331713
- Idaho Falls PediatricsCertificate of Waiver, Physician office13D0969818
- Medical Research PartnersCertificate of Waiver, Other13D2304891
- Meridian Advanced PsychiatryCertificate of Waiver, Independent13D2284675
- Pearl Health ClinicCertificate of Waiver, Physician office13D2020492
- Promontory Point RehabilitationCertificate of Waiver, Skilled nursing or nursing facility13D2006945
- Rehabilitative Health ServicesCertificate of Compliance, Physician office13D2032859
Related
Questions
What is the CLIA number for Broulim's Pharmacy #17 in Ammon?
13D2167140, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Broulim's Pharmacy #17 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 13D2167140 expire?
The CMS file lists June 2, 2027 as the certificate expiration date; the certificate took effect June 3, 2025.