05D2079737 CLIA NUMBER - SAFEWAY PHARMACY #1259

Laboratory Demographics

  • CLIA Code: 05D2079737
  • Facility Name: SAFEWAY PHARMACY #1259
  • Facility Address: 3365 DEER VALLEY RD
    ANTIOCH, CA
    ZIP 94531
  • Facility Phone: 925 706-4152
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HAN KIEU
  • NPI Number: 1720017734
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2079737
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1259
Street 3365 DEER VALLEY RD
City ANTIOCH
State CA
ZIP 94531
Phone 925 706-4152
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Pharmacy
Lab Director HAN KIEU

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