05D2111282 CLIA NUMBER - SAFEWAY PHARMACY #1824

Laboratory Demographics

  • CLIA Code: 05D2111282
  • Facility Name: SAFEWAY PHARMACY #1824
  • Facility Address: 1020 JOHNSON LN
    SOUTH LAKE TAHOE, CA
    ZIP 96150
  • Facility Phone: 530 542-7744
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEAN M. YANG, PIC
  • NPI Number: 1124057153
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2111282
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #1824
Street 1020 JOHNSON LN
City SOUTH LAKE TAHOE
State CA
ZIP 96150
Phone 530 542-7744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2024
Certificate Expiration Date 4/3/2026
Facility Type Pharmacy
Lab Director JEAN M. YANG, PIC

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