05D2259459 CLIA NUMBER - WALGREENS #09021

Laboratory Demographics

  • CLIA Code: 05D2259459
  • Facility Name: WALGREENS #09021
  • Facility Address: 1811 S SAN JACINTO AVE
    SAN JACINTO, CA
    ZIP 92583
  • Facility Phone: 951 487-6185
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIANA O. FALODUN
  • NPI Number: 1629238829
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2259459
LAB Type Pharmacy
Facility Name WALGREENS #09021
Street 1811 S SAN JACINTO AVE
City SAN JACINTO
State CA
ZIP 92583
Phone 951 487-6185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Pharmacy
Lab Director DIANA O. FALODUN

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