05D2062652 CLIA NUMBER - WALGREENS #00625

Laboratory Demographics

  • CLIA Code: 05D2062652
  • Facility Name: WALGREENS #00625
  • Facility Address: 615 BROADWAY
    MILLBRAE, CA
    ZIP 94030
  • Facility Phone: 650 697-0166
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: SASHIDARAN MOODLEY
  • NPI Number: 1053326322
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2062652
LAB Type Other - CLINIC
Facility Name WALGREENS #00625
Street 615 BROADWAY
City MILLBRAE
State CA
ZIP 94030
Phone 650 697-0166
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Other - CLINIC
Lab Director SASHIDARAN MOODLEY

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