05D2057762 CLIA NUMBER - SAFEWAY PHARMACY #1883

Laboratory Demographics

  • CLIA Code: 05D2057762
  • Facility Name: SAFEWAY PHARMACY #1883
  • Facility Address: 103 AMERICAN CANYON RD
    AMERICAN CANYON, CA
    ZIP 94503
  • Facility Phone: 707 649-5160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROSS MILLER
  • NPI Number: 1205865235
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2057762
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1883
Street 103 AMERICAN CANYON RD
City AMERICAN CANYON
State CA
ZIP 94503
Phone 707 649-5160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2023
Certificate Expiration Date 4/22/2025
Facility Type Pharmacy
Lab Director ROSS MILLER

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This page was last updated on: 3/20/2025