05D2063079 CLIA NUMBER - WALGREENS #13657

Laboratory Demographics

  • CLIA Code: 05D2063079
  • Facility Name: WALGREENS #13657
  • Facility Address: 12574 LIMONITE AVE
    MIRA LOMA, CA
    ZIP 91752
  • Facility Phone: 951 520-0187
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIFFANY T. NGUYEN
  • NPI Number: 1730475435
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2063079
LAB Type Pharmacy
Facility Name WALGREENS #13657
Street 12574 LIMONITE AVE
City MIRA LOMA
State CA
ZIP 91752
Phone 951 520-0187
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Pharmacy
Lab Director TIFFANY T. NGUYEN

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