05D2058052 CLIA NUMBER - SAFEWAY PHARMACY #0783

Laboratory Demographics

  • CLIA Code: 05D2058052
  • Facility Name: SAFEWAY PHARMACY #0783
  • Facility Address: 3540 MT DIABLO BLVD
    LAFAYETTE, CA
    ZIP 94549
  • Facility Phone: 925 284-1550
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOE JIRAVISITCUL
  • NPI Number: 1437188455
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058052
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0783
Street 3540 MT DIABLO BLVD
City LAFAYETTE
State CA
ZIP 94549
Phone 925 284-1550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Pharmacy
Lab Director JOE JIRAVISITCUL

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