05D2063617 CLIA NUMBER - WALGREENS # 04559

Laboratory Demographics

  • CLIA Code: 05D2063617
  • Facility Name: WALGREENS # 04559
  • Facility Address: 227 SHORELINE HWY.
    MILL VALLEY, CA
    ZIP 94941
  • Facility Phone: 415 380-8402
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARYAM HAVAEL
  • NPI Number: 1205841582
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2063617
LAB Type Pharmacy
Facility Name WALGREENS # 04559
Street 227 SHORELINE HWY.
City MILL VALLEY
State CA
ZIP 94941
Phone 415 380-8402
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director MARYAM HAVAEL

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