05D2062262 CLIA NUMBER - WALGREENS # 12143

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Laboratory Demographics

CLIA Number: 05D2062262

Facility Name: WALGREENS # 12143

Facility Address:
5504 BALBOA AVE.
SAN DIEGO, CA
ZIP 92111
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Facility Phone Number: 858 495-9155

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1780849588

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	05D2062262
LAB Type	Pharmacy
Facility Name	WALGREENS # 12143
Street	5504 BALBOA AVE.
City	SAN DIEGO
State	CA
ZIP	92111
Phone	858 495-9155
CertificateType	4
CertificateEffectiveDate	5/5/2023
CertificateExpirationDate	5/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024