05D2091907 CLIA NUMBER - SAFEWAY PHARMACY # 1592

Laboratory Demographics

  • CLIA Code: 05D2091907
  • Facility Name: SAFEWAY PHARMACY # 1592
  • Facility Address: 7815 NORTH LAKE BOULEVARD
    KINGS BEACH, CA
    ZIP 96143
  • Facility Phone: 530 546-0186
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTARA SHERGILL-HIRSH, PIC
  • NPI Number: 1912918053
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2091907
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY # 1592
Street 7815 NORTH LAKE BOULEVARD
City KINGS BEACH
State CA
ZIP 96143
Phone 530 546-0186
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2025
Certificate Expiration Date 2/19/2027
Facility Type Pharmacy
Lab Director ANTARA SHERGILL-HIRSH, PIC

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