05D2295210 CLIA NUMBER - WALGREENS 02612

Laboratory Demographics

  • CLIA Code: 05D2295210
  • Facility Name: WALGREENS 02612
  • Facility Address: 200 N WINCHESTER BLVD
    SANTA CLARA, CA
    ZIP 95050
  • Facility Phone: 408 247-1894
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN R. LEE
  • NPI Number: 1316953979
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2295210
LAB Type Pharmacy
Facility Name WALGREENS 02612
Street 200 N WINCHESTER BLVD
City SANTA CLARA
State CA
ZIP 95050
Phone 408 247-1894
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Pharmacy
Lab Director JOHN R. LEE

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