05D2059173 CLIA NUMBER - SAFEWAY PHARMACY #3011

Laboratory Demographics

  • CLIA Code: 05D2059173
  • Facility Name: SAFEWAY PHARMACY #3011
  • Facility Address: 389 S MCDOWELL BLVD
    PETALUMA, CA
    ZIP 94952
  • Facility Phone: 707 766-9477
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROSS MILLER
  • NPI Number: 1962448571
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2059173
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #3011
Street 389 S MCDOWELL BLVD
City PETALUMA
State CA
ZIP 94952
Phone 707 766-9477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/20/2025
Certificate Expiration Date 5/19/2027
Facility Type Pharmacy
Lab Director ROSS MILLER

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