03D2072812 CLIA NUMBER - SAFEWAY PHARMACY #216

Laboratory Demographics

  • CLIA Code: 03D2072812
  • Facility Name: SAFEWAY PHARMACY #216
  • Facility Address: 1650 MCCULLOCH BLVD N
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 855-9200
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANE KORTAN
  • NPI Number: 1811926868
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2072812
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #216
Street 1650 MCCULLOCH BLVD N
City LAKE HAVASU CITY
State AZ
ZIP 86403
Phone 928 855-9200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2024
Certificate Expiration Date 3/22/2026
Facility Type Pharmacy
Lab Director SHANE KORTAN

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