05D2060258 CLIA NUMBER - SAFEWAY PHARMACY # 3124

Laboratory Demographics

  • CLIA Code: 05D2060258
  • Facility Name: SAFEWAY PHARMACY # 3124
  • Facility Address: 1187 S MAIN ST.
    MANTECA, CA
    ZIP 95337
  • Facility Phone: 209 239-1809
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM J. CHEW
  • NPI Number: 1720235211
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2060258
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY # 3124
Street 1187 S MAIN ST.
City MANTECA
State CA
ZIP 95337
Phone 209 239-1809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type Pharmacy
Lab Director WILLIAM J. CHEW

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