05D2297534 CLIA NUMBER - WALGREENS 02265

Laboratory Demographics

  • CLIA Code: 05D2297534
  • Facility Name: WALGREENS 02265
  • Facility Address: 1130 BIRD AVE
    SAN JOSE, CA
    ZIP 95125
  • Facility Phone: 408 295-7768
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ZHENG GONG
  • NPI Number: 1598042905
  • Taxonomy: 302F00000X - Exclusive Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 05D2297534
LAB Type Pharmacy
Facility Name WALGREENS 02265
Street 1130 BIRD AVE
City SAN JOSE
State CA
ZIP 95125
Phone 408 295-7768
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Pharmacy
Lab Director ZHENG GONG

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