05D2259224 CLIA NUMBER - WALGREENS #05652

Laboratory Demographics

  • CLIA Code: 05D2259224
  • Facility Name: WALGREENS #05652
  • Facility Address: 6400 HAVEN AVE
    RANCHO CUCAMONGA, CA
    ZIP 91737
  • Facility Phone: 909 941-3857
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BLESSY REDDY
  • NPI Number: 1710992003
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2259224
LAB Type Pharmacy
Facility Name WALGREENS #05652
Street 6400 HAVEN AVE
City RANCHO CUCAMONGA
State CA
ZIP 91737
Phone 909 941-3857
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/3/2024
Certificate Expiration Date 5/2/2026
Facility Type Pharmacy
Lab Director BLESSY REDDY

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