05D2295077 CLIA NUMBER - WALGREENS 02223

Laboratory Demographics

  • CLIA Code: 05D2295077
  • Facility Name: WALGREENS 02223
  • Facility Address: 17383 MAIN ST
    HESPERIA, CA
    ZIP 92345
  • Facility Phone: 760 948-0481
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NGUYEN QUANG
  • NPI Number: 1518974575
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2295077
LAB Type Pharmacy
Facility Name WALGREENS 02223
Street 17383 MAIN ST
City HESPERIA
State CA
ZIP 92345
Phone 760 948-0481
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Pharmacy
Lab Director NGUYEN QUANG

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