05D2205741 CLIA NUMBER - SAFEWAY PHARMACY #0748

Laboratory Demographics

  • CLIA Code: 05D2205741
  • Facility Name: SAFEWAY PHARMACY #0748
  • Facility Address: 3383 BASS LAKE ROAD
    EL DORADO HILLS, CA
    ZIP 95762
  • Facility Phone: 530 313-4925
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN NICOLETTE
  • NPI Number: 1528127990
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2205741
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0748
Street 3383 BASS LAKE ROAD
City EL DORADO HILLS
State CA
ZIP 95762
Phone 530 313-4925
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Pharmacy
Lab Director JOHN NICOLETTE

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