05D2296734 CLIA NUMBER - WALGREENS 04198

Laboratory Demographics

  • CLIA Code: 05D2296734
  • Facility Name: WALGREENS 04198
  • Facility Address: 1351 W CAPITOL AVE
    WEST SACRAMENTO, CA
    ZIP 95691
  • Facility Phone: 916 371-3801
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EDMUND KONG
  • NPI Number: 1093720377
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2296734
LAB Type Pharmacy
Facility Name WALGREENS 04198
Street 1351 W CAPITOL AVE
City WEST SACRAMENTO
State CA
ZIP 95691
Phone 916 371-3801
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Pharmacy
Lab Director EDMUND KONG

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This page was last updated on: 6/4/2025