05D2091960 CLIA NUMBER - SAFEWAY PHARMACY #1724

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Laboratory Demographics

CLIA Number: 05D2091960

Facility Name: SAFEWAY PHARMACY #1724

Facility Address:
3955 MISSOURI FLAT RD
PLACERVILLE, CA
ZIP 95667
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Facility Phone Number: 530 295-2977

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1437188471

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D2091960
LAB Type	Pharmacy
Facility Name	SAFEWAY PHARMACY #1724
Street	3955 MISSOURI FLAT RD
City	PLACERVILLE
State	CA
ZIP	95667
Phone	530 295-2977
CertificateType	4
CertificateEffectiveDate	2/23/2023
CertificateExpirationDate	2/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024