03D2073042 CLIA NUMBER - SAFEWAY PHARMACY #1717

Laboratory Demographics

  • CLIA Code: 03D2073042
  • Facility Name: SAFEWAY PHARMACY #1717
  • Facility Address: 1960 W MAIN ST
    MESA, AZ
    ZIP 85201
  • Facility Phone: 480 644-8873
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GEORGE DAROUICHE
  • NPI Number: 1801825872
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2073042
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1717
Street 1960 W MAIN ST
City MESA
State AZ
ZIP 85201
Phone 480 644-8873
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2024
Certificate Expiration Date 2/9/2026
Facility Type Pharmacy
Lab Director GEORGE DAROUICHE

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