05D2298890 CLIA NUMBER - CVS/PHARMACY #04148

Laboratory Demographics

  • CLIA Code: 05D2298890
  • Facility Name: CVS/PHARMACY #04148
  • Facility Address: 14426 PALMDALE RD
    VICTORVILLE, CA
    ZIP 92392
  • Facility Phone: 760 243-1771
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SETH OWUOR
  • NPI Number: 1740598689
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2298890
LAB Type Pharmacy
Facility Name CVS/PHARMACY #04148
Street 14426 PALMDALE RD
City VICTORVILLE
State CA
ZIP 92392
Phone 760 243-1771
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Pharmacy
Lab Director SETH OWUOR

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