05D2295553 CLIA NUMBER - WALGREENS 04107

Laboratory Demographics

  • CLIA Code: 05D2295553
  • Facility Name: WALGREENS 04107
  • Facility Address: 10 W MAIN ST
    WOODLAND, CA
    ZIP 95695
  • Facility Phone: 530 668-8589
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL NGO
  • NPI Number: 1922013218
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2295553
LAB Type Pharmacy
Facility Name WALGREENS 04107
Street 10 W MAIN ST
City WOODLAND
State CA
ZIP 95695
Phone 530 668-8589
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Pharmacy
Lab Director PAUL NGO

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