05D2091960 CLIA NUMBER - SAFEWAY PHARMACY #1724

Laboratory Demographics

  • CLIA Code: 05D2091960
  • Facility Name: SAFEWAY PHARMACY #1724
  • Facility Address: 3955 MISSOURI FLAT RD
    PLACERVILLE, CA
    ZIP 95667
  • Facility Phone: 530 295-2977
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACKIE LYN VELASCO
  • NPI Number: 1437188471
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2025
Certificate Expiration Date 2/22/2027
Facility Type Pharmacy
Lab Director JACKIE LYN VELASCO

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This page was last updated on: 6/4/2025