05D2062152 CLIA NUMBER - SAFEWAY PHARMACY #0932

Laboratory Demographics

  • CLIA Code: 05D2062152
  • Facility Name: SAFEWAY PHARMACY #0932
  • Facility Address: 350 NORTHGATE ONE
    SAN RAFAEL, CA
    ZIP 94903
  • Facility Phone: 415 472-8221
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUZANNE IACOVELLI
  • NPI Number: 1164451183
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2062152
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0932
Street 350 NORTHGATE ONE
City SAN RAFAEL
State CA
ZIP 94903
Phone 415 472-8221
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Pharmacy
Lab Director SUZANNE IACOVELLI

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