05D2295560 CLIA NUMBER - WALGREENS 02842

Laboratory Demographics

  • CLIA Code: 05D2295560
  • Facility Name: WALGREENS 02842
  • Facility Address: 840 OAKDALE RD
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 571-9075
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GEORGE YOUSIP
  • NPI Number: 1780699066
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2295560
LAB Type Pharmacy
Facility Name WALGREENS 02842
Street 840 OAKDALE RD
City MODESTO
State CA
ZIP 95355
Phone 209 571-9075
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 GEORGE YOUSIP

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