05D2262254 CLIA NUMBER - WALGREENS #13812

Laboratory Demographics

  • CLIA Code: 05D2262254
  • Facility Name: WALGREENS #13812
  • Facility Address: 14885 TELEGRAPH ROAD
    LA MIRADA, CA
    ZIP 90638
  • Facility Phone: 562 777-3405
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: SASHIDARAN MOODLEY
  • NPI Number: 1508871872
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2262254
LAB Type Other - CLINIC
Facility Name WALGREENS #13812
Street 14885 TELEGRAPH ROAD
City LA MIRADA
State CA
ZIP 90638
Phone 562 777-3405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Other - CLINIC
Lab Director SASHIDARAN MOODLEY

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