05D2297167 CLIA NUMBER - WALGREENS 05220

Laboratory Demographics

  • CLIA Code: 05D2297167
  • Facility Name: WALGREENS 05220
  • Facility Address: 12275 PERROS BLVD
    MORENO VALLEY, CA
    ZIP 92557
  • Facility Phone: 951 242-8717
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NGOC NGUYEN
  • NPI Number: 1427063700
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2297167
LAB Type Pharmacy
Facility Name WALGREENS 05220
Street 12275 PERROS BLVD
City MORENO VALLEY
State CA
ZIP 92557
Phone 951 242-8717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Pharmacy
Lab Director NGOC NGUYEN

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