05D2297184 CLIA NUMBER - WALGREENS 04049

Laboratory Demographics

  • CLIA Code: 05D2297184
  • Facility Name: WALGREENS 04049
  • Facility Address: 3630 SAN PABLO DAM RD
    EL SOBRANTE, CA
    ZIP 94803
  • Facility Phone: 510 758-2365
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEFA CORONEL
  • NPI Number: 1952316242
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2297184
LAB Type Pharmacy
Facility Name WALGREENS 04049
Street 3630 SAN PABLO DAM RD
City EL SOBRANTE
State CA
ZIP 94803
Phone 510 758-2365
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 JOSEFA CORONEL

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