05D2162259 CLIA NUMBER - CREEKSIDE PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2162259
  • Facility Name: CREEKSIDE PHARMACY
  • Facility Address: 95 MONTGOMERY DR, STE 108
    SANTA ROSA, CA
    ZIP 95404
  • Facility Phone: 707 525-1130
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANYAMANEE MALAKHAM
  • NPI Number: 1497814594
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2162259
LAB Type Pharmacy
Facility Name CREEKSIDE PHARMACY
Street 95 MONTGOMERY DR, STE 108
City SANTA ROSA
State CA
ZIP 95404
Phone 707 525-1130
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 ANYAMANEE MALAKHAM

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