05D0868967 CLIA NUMBER - CORCORAN STATE PRISON CTC LAB

Laboratory Demographics

  • CLIA Code: 05D0868967
  • Facility Name: CORCORAN STATE PRISON CTC LAB
  • Facility Address: 4001 KING AVE
    CORCORAN, CA
    ZIP 93212
  • Facility Phone: 559 992-8800
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: MARIE A. RUSSELL
  • NPI Number: 1376190876
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0868967
LAB Type Prison
Facility Name CORCORAN STATE PRISON CTC LAB
Street 4001 KING AVE
City CORCORAN
State CA
ZIP 93212
Phone 559 992-8800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2025
Certificate Expiration Date 1/11/2027
Facility Type Prison
Lab Director MARIE A. RUSSELL

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