05D2290220 CLIA NUMBER - SAFEWAY PHARMACY #0713

Laboratory Demographics

  • CLIA Code: 05D2290220
  • Facility Name: SAFEWAY PHARMACY #0713
  • Facility Address: 100 CALISTOGA RD
    SANTA ROSA, CA
    ZIP 95409
  • Facility Phone: 707 539-2129
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONNA KE SUN
  • NPI Number: 1417986431
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2290220
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0713
Street 100 CALISTOGA RD
City SANTA ROSA
State CA
ZIP 95409
Phone 707 539-2129
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2025
Certificate Expiration Date 9/20/2027
Facility Type Pharmacy
Lab Director DONNA KE SUN

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