05D2058278 CLIA NUMBER - SAFEWAY PHARMACY #0983

Laboratory Demographics

  • CLIA Code: 05D2058278
  • Facility Name: SAFEWAY PHARMACY #0983
  • Facility Address: 1071 11TH ST
    LAKEPORT, CA
    ZIP 95453
  • Facility Phone: 707 263-8779
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JIHO JANG
  • NPI Number: 1376793521
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058278
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0983
Street 1071 11TH ST
City LAKEPORT
State CA
ZIP 95453
Phone 707 263-8779
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2023
Certificate Expiration Date 5/2/2025
Facility Type Pharmacy
Lab Director JIHO JANG

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