05D2222601 CLIA NUMBER - WALGREENS #07976

Laboratory Demographics

  • CLIA Code: 05D2222601
  • Facility Name: WALGREENS #07976
  • Facility Address: 800 E LUGONIA AVE
    REDLANDS, CA
    ZIP 92374
  • Facility Phone: 909 307-6964
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL AGBONKPOLO
  • NPI Number: 1659456507
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2222601
LAB Type Pharmacy
Facility Name WALGREENS #07976
Street 800 E LUGONIA AVE
City REDLANDS
State CA
ZIP 92374
Phone 909 307-6964
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Pharmacy
Lab Director SAMUEL AGBONKPOLO

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