05D2297008 CLIA NUMBER - WALGREENS 04331

Laboratory Demographics

  • CLIA Code: 05D2297008
  • Facility Name: WALGREENS 04331
  • Facility Address: 401 PARADISE RD
    MODESTO, CA
    ZIP 95351
  • Facility Phone: 209 575-3257
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL RODRIGUEZ
  • NPI Number: 1750395083
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2297008
LAB Type Pharmacy
Facility Name WALGREENS 04331
Street 401 PARADISE RD
City MODESTO
State CA
ZIP 95351
Phone 209 575-3257
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Pharmacy
Lab Director SAMUEL RODRIGUEZ

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