03D2111176 CLIA NUMBER - ALBERTSONS PHARMACY #3204

Laboratory Demographics

  • CLIA Code: 03D2111176
  • Facility Name: ALBERTSONS PHARMACY #3204
  • Facility Address: 1980 MCCULLOCH BLVD
    LAKE HAVASU CITY, AZ
    ZIP 86403
  • Facility Phone: 928 854-8281
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRERANA SEVAK
  • NPI Number: 1346605185
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2111176
LAB Type Pharmacy
Facility Name ALBERTSONS PHARMACY #3204
Street 1980 MCCULLOCH BLVD
City LAKE HAVASU CITY
State AZ
ZIP 86403
Phone 928 854-8281
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Pharmacy
Lab Director PRERANA SEVAK

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