03D2109239 CLIA NUMBER - ALBERTSONS PHARMACY #0025

Laboratory Demographics

  • CLIA Code: 03D2109239
  • Facility Name: ALBERTSONS PHARMACY #0025
  • Facility Address: 21001 N TATUM BLVD STE 76
    PHOENIX, AZ
    ZIP 85050
  • Facility Phone: 480 585-1510
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NEIL CORONADO
  • NPI Number: 1396113510
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2109239
LAB Type Pharmacy
Facility Name ALBERTSONS PHARMACY #0025
Street 21001 N TATUM BLVD STE 76
City PHOENIX
State AZ
ZIP 85050
Phone 480 585-1510
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2024
Certificate Expiration Date 2/21/2026
Facility Type Pharmacy
Lab Director NEIL CORONADO

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