05D2300314 CLIA NUMBER - WALGREENS 11243

Laboratory Demographics

  • CLIA Code: 05D2300314
  • Facility Name: WALGREENS 11243
  • Facility Address: 11930 STUDEBAKER RD
    NORWALK, CA
    ZIP 90650
  • Facility Phone: 562 864-8138
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS TEDJAKESUMA
  • NPI Number: 1942460217
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2300314
LAB Type Pharmacy
Facility Name WALGREENS 11243
Street 11930 STUDEBAKER RD
City NORWALK
State CA
ZIP 90650
Phone 562 864-8138
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Pharmacy
Lab Director NICHOLAS TEDJAKESUMA

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