05D2283544 CLIA NUMBER - GREEN VALLEY PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2283544
  • Facility Name: GREEN VALLEY PHARMACY
  • Facility Address: 8237 ROCHESTER AVE STE 120
    RANCHO CUCAMONGA, CA
    ZIP 91730
  • Facility Phone: 909 980-0999
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WAI TAI WONG
  • NPI Number: 1699122002
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2283544
LAB Type Pharmacy
Facility Name GREEN VALLEY PHARMACY
Street 8237 ROCHESTER AVE STE 120
City RANCHO CUCAMONGA
State CA
ZIP 91730
Phone 909 980-0999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Pharmacy
Lab Director WAI TAI WONG

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