05D2219604 CLIA NUMBER - WALGREENS #10482

Laboratory Demographics

  • CLIA Code: 05D2219604
  • Facility Name: WALGREENS #10482
  • Facility Address: 7850 WEST LN
    STOCKTON, CA
    ZIP 95210
  • Facility Phone: 209 473-9515
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIMON WONG
  • NPI Number: 1396928347
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2219604
LAB Type Pharmacy
Facility Name WALGREENS #10482
Street 7850 WEST LN
City STOCKTON
State CA
ZIP 95210
Phone 209 473-9515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director SIMON WONG

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