05D2079747 CLIA NUMBER - SAFEWAY PHARMACY #2778

Laboratory Demographics

  • CLIA Code: 05D2079747
  • Facility Name: SAFEWAY PHARMACY #2778
  • Facility Address: 12110 INDUSTRY BLVD
    JACKSON, CA
    ZIP 95642
  • Facility Phone: 209 257-0786
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHIVANI RAINA
  • NPI Number: 1093744039
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2079747
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #2778
Street 12110 INDUSTRY BLVD
City JACKSON
State CA
ZIP 95642
Phone 209 257-0786
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Pharmacy
Lab Director SHIVANI RAINA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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