05D2286456 CLIA NUMBER - WALGREENS HEALTH CORNER 50020

Laboratory Demographics

  • CLIA Code: 05D2286456
  • Facility Name: WALGREENS HEALTH CORNER 50020
  • Facility Address: 934 N HACIENDA BLVD SUITE 101
    LA PUENTE, CA
    ZIP 91744
  • Facility Phone: 626 709-9111
  • Facility Type: Other - HEALTH CLINIC
  • Facility Type: Waiver
  • Lab Director: SASHIDARAN M. MOODLEY
  • NPI Number: 1922013259
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2286456
LAB Type Other - HEALTH CLINIC
Facility Name WALGREENS HEALTH CORNER 50020
Street 934 N HACIENDA BLVD SUITE 101
City LA PUENTE
State CA
ZIP 91744
Phone 626 709-9111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Other - HEALTH CLINIC
Lab Director SASHIDARAN M. MOODLEY

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