05D2060621 CLIA NUMBER - WALGREENS #12573

Laboratory Demographics

  • CLIA Code: 05D2060621
  • Facility Name: WALGREENS #12573
  • Facility Address: 16201 HARBOR BLVD ,
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 839-3496
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAO VU-HO, PIC
  • NPI Number: 1659387025
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2060621
LAB Type Pharmacy
Facility Name WALGREENS #12573
Street 16201 HARBOR BLVD ,
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 839-3496
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Pharmacy
Lab Director DAO VU-HO, PIC

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