05D2254261 CLIA NUMBER - WALGREENS #04517

Laboratory Demographics

  • CLIA Code: 05D2254261
  • Facility Name: WALGREENS #04517
  • Facility Address: 2600 MOWRY AVENUE
    FREMONT, CA
    ZIP 94538
  • Facility Phone: 510 742-9356
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: SASHIDARAN MOODLEY
  • NPI Number: 1255346581
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2254261
LAB Type Other - CLINIC
Facility Name WALGREENS #04517
Street 2600 MOWRY AVENUE
City FREMONT
State CA
ZIP 94538
Phone 510 742-9356
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Other - CLINIC
Lab Director SASHIDARAN MOODLEY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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