05D2297177 CLIA NUMBER - WALGREENS 05480

Laboratory Demographics

  • CLIA Code: 05D2297177
  • Facility Name: WALGREENS 05480
  • Facility Address: 1833 N MILPITAS BLVD
    MILPITAS, CA
    ZIP 95035
  • Facility Phone: 408 262-7774
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIEN PHUNG
  • NPI Number: 1518972892
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2297177
LAB Type Pharmacy
Facility Name WALGREENS 05480
Street 1833 N MILPITAS BLVD
City MILPITAS
State CA
ZIP 95035
Phone 408 262-7774
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 TIEN PHUNG

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