05D2290950 CLIA NUMBER - CVS/PHARMACY #09792

Laboratory Demographics

  • CLIA Code: 05D2290950
  • Facility Name: CVS/PHARMACY #09792
  • Facility Address: 690 EAST FOOTHILL BLVD
    UPLAND, CA
    ZIP 91786
  • Facility Phone: 909 608-7419
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANCHANA KASEMSUWAN
  • NPI Number: 1841234192
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2290950
LAB Type Pharmacy
Facility Name CVS/PHARMACY #09792
Street 690 EAST FOOTHILL BLVD
City UPLAND
State CA
ZIP 91786
Phone 909 608-7419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2023
Certificate Expiration Date 10/2/2025
Facility Type Pharmacy
Lab Director ANCHANA KASEMSUWAN

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This page was last updated on: 3/20/2025