05D2300341 CLIA NUMBER - WALGREENS 12841

Laboratory Demographics

  • CLIA Code: 05D2300341
  • Facility Name: WALGREENS 12841
  • Facility Address: 22456 BARTON RD
    GRAND TERRACE, CA
    ZIP 92313
  • Facility Phone: 909 824-2619
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JANYCE N. MAI
  • NPI Number: 1437404266
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2300341
LAB Type Pharmacy
Facility Name WALGREENS 12841
Street 22456 BARTON RD
City GRAND TERRACE
State CA
ZIP 92313
Phone 909 824-2619
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 JANYCE N. MAI

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