05D2083163 CLIA NUMBER - SAFEWAY PHARMACY #1576

Laboratory Demographics

  • CLIA Code: 05D2083163
  • Facility Name: SAFEWAY PHARMACY #1576
  • Facility Address: 2300 MENDOCINO AVE
    SANTA ROSA, CA
    ZIP 95403
  • Facility Phone: 707 569-3111
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: QUYEN HOANG
  • NPI Number: 1639115249
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2083163
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1576
Street 2300 MENDOCINO AVE
City SANTA ROSA
State CA
ZIP 95403
Phone 707 569-3111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Pharmacy
Lab Director QUYEN HOANG

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