05D2071001 CLIA NUMBER - SAFEWAY PHARMACY #0954

Laboratory Demographics

  • CLIA Code: 05D2071001
  • Facility Name: SAFEWAY PHARMACY #0954
  • Facility Address: 475 M ST
    CRESCENT CITY, CA
    ZIP 95531
  • Facility Phone: 707 465-3663
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENDALL A. MEMBRENO
  • NPI Number: 1689603631
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2071001
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0954
Street 475 M ST
City CRESCENT CITY
State CA
ZIP 95531
Phone 707 465-3663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Pharmacy
Lab Director KENDALL A. MEMBRENO

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