05D2080549 CLIA NUMBER - SAFEWAY PHARMACY # 1617

Laboratory Demographics

  • CLIA Code: 05D2080549
  • Facility Name: SAFEWAY PHARMACY # 1617
  • Facility Address: 8640 SIERRA COLLEGE BLVD
    ROSEVILLE, CA
    ZIP 95661
  • Facility Phone: 916 783-2304
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONALD W. GUBBINS JR
  • NPI Number: 1962431908
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2080549
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY # 1617
Street 8640 SIERRA COLLEGE BLVD
City ROSEVILLE
State CA
ZIP 95661
Phone 916 783-2304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Pharmacy
Lab Director DONALD W. GUBBINS JR

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