03D2073032 CLIA NUMBER - SAFEWAY PHARMACY #1584

Laboratory Demographics

  • CLIA Code: 03D2073032
  • Facility Name: SAFEWAY PHARMACY #1584
  • Facility Address: 1999 W WICKENBURG WAY
    WICKENBURG, AZ
    ZIP 85390
  • Facility Phone: 928 684-2995
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOHAMMED A. FATLAWI
  • NPI Number: 1710916788
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2073032
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1584
Street 1999 W WICKENBURG WAY
City WICKENBURG
State AZ
ZIP 85390
Phone 928 684-2995
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 MOHAMMED A. FATLAWI

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