05D2222012 CLIA NUMBER - WALGREENS #10881

Laboratory Demographics

  • CLIA Code: 05D2222012
  • Facility Name: WALGREENS #10881
  • Facility Address: 880 SUTTON WAY
    GRASS VALLEY, CA
    ZIP 95945
  • Facility Phone: 530 271-1021
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TANYA LE
  • NPI Number: 1912220484
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2222012
LAB Type Pharmacy
Facility Name WALGREENS #10881
Street 880 SUTTON WAY
City GRASS VALLEY
State CA
ZIP 95945
Phone 530 271-1021
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Pharmacy
Lab Director TANYA LE

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