05D2058057 CLIA NUMBER - SAFEWAY PHARMACY #1757

Laboratory Demographics

  • CLIA Code: 05D2058057
  • Facility Name: SAFEWAY PHARMACY #1757
  • Facility Address: 591 TRES PINOS RD.
    HOLLISTER, CA
    ZIP 95023
  • Facility Phone: 831 638-3247
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RANDA AWAD
  • NPI Number: 1629007646
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058057
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1757
Street 591 TRES PINOS RD.
City HOLLISTER
State CA
ZIP 95023
Phone 831 638-3247
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type Pharmacy
Lab Director RANDA AWAD

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This page was last updated on: 6/4/2025