05D2298005 CLIA NUMBER - WALGREENS 03711

Laboratory Demographics

CLIA Number: 05D2298005

Facility Name: WALGREENS 03711

Facility Address:
1189 POTRERO AVE
SAN FRANCISCO, CA
ZIP 94110
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Facility Phone Number: 415 647-1397

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1841206414

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	05D2298005
LAB Type	Pharmacy
Facility Name	WALGREENS 03711
Street	1189 POTRERO AVE
City	SAN FRANCISCO
State	CA
ZIP	94110
Phone	415 647-1397
CertificateType	4
CertificateEffectiveDate	1/25/2024
CertificateExpirationDate	1/24/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024