05D2059176 CLIA NUMBER - SAFEWAY PHARMACY #1631

Laboratory Demographics

  • CLIA Code: 05D2059176
  • Facility Name: SAFEWAY PHARMACY #1631
  • Facility Address: 122 ROBLES WAY
    VALLEJO, CA
    ZIP 94591
  • Facility Phone: 707 554-6908
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BOAZ M. CHUNG
  • NPI Number: 1326074105
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2059176
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1631
Street 122 ROBLES WAY
City VALLEJO
State CA
ZIP 94591
Phone 707 554-6908
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 BOAZ M. CHUNG

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