05D1057402 CLIA NUMBER - SAFEWAY PHARMACY # 1769

Laboratory Demographics

  • CLIA Code: 05D1057402
  • Facility Name: SAFEWAY PHARMACY # 1769
  • Facility Address: 2808 COUNTRY CLUB BLVD
    STOCKTON, CA
    ZIP 95204
  • Facility Phone: 209 461-5560
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RONALD J. FRAZIER
  • NPI Number: 1629014261
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1057402
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY # 1769
Street 2808 COUNTRY CLUB BLVD
City STOCKTON
State CA
ZIP 95204
Phone 209 461-5560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Pharmacy
Lab Director RONALD J. FRAZIER

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