05D2284229 CLIA NUMBER - SAFEWAY PHARMACY #0055

Laboratory Demographics

  • CLIA Code: 05D2284229
  • Facility Name: SAFEWAY PHARMACY #0055
  • Facility Address: 19555 S MOUNTIAN HOUSE PKWY
    MOUNTAIN HOUSE, CA
    ZIP 95391
  • Facility Phone: 209 362-1260
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BATRA AMANDEEP
  • NPI Number: 1992441950
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2284229
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0055
Street 19555 S MOUNTIAN HOUSE PKWY
City MOUNTAIN HOUSE
State CA
ZIP 95391
Phone 209 362-1260
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Pharmacy
Lab Director BATRA AMANDEEP

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