05D2060259 CLIA NUMBER - SAFEWAY PHARMACY #1648

Laboratory Demographics

  • CLIA Code: 05D2060259
  • Facility Name: SAFEWAY PHARMACY #1648
  • Facility Address: 2449 W. KETTLEMAN LANE
    LODI, CA
    ZIP 95242
  • Facility Phone: 209 367-7882
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CAITLIN TIPPLE
  • NPI Number: 1629007638
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2060259
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1648
Street 2449 W. KETTLEMAN LANE
City LODI
State CA
ZIP 95242
Phone 209 367-7882
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 CAITLIN TIPPLE

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