05D2063754 CLIA NUMBER - WALGREENS #02865

Laboratory Demographics

  • CLIA Code: 05D2063754
  • Facility Name: WALGREENS #02865
  • Facility Address: 1101 MCHENRY AVE.
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 577-8695
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WINRICH L. QUIBOLOY
  • NPI Number: 1841205119
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2063754
LAB Type Pharmacy
Facility Name WALGREENS #02865
Street 1101 MCHENRY AVE.
City MODESTO
State CA
ZIP 95350
Phone 209 577-8695
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/26/2024
Certificate Expiration Date 7/25/2026
Facility Type Pharmacy
Lab Director WINRICH L. QUIBOLOY

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