05D2295970 CLIA NUMBER - WALGREENS 02644

Laboratory Demographics

  • CLIA Code: 05D2295970
  • Facility Name: WALGREENS 02644
  • Facility Address: 2010 ALAMO DR
    VACAVILLE, CA
    ZIP 95687
  • Facility Phone: 707 451-8304
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIMON WONG
  • NPI Number: 1144235425
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2295970
LAB Type Pharmacy
Facility Name WALGREENS 02644
Street 2010 ALAMO DR
City VACAVILLE
State CA
ZIP 95687
Phone 707 451-8304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Pharmacy
Lab Director SIMON WONG

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