05D2300342 CLIA NUMBER - WALGREENS 12576

Laboratory Demographics

  • CLIA Code: 05D2300342
  • Facility Name: WALGREENS 12576
  • Facility Address: 15318 ROY RODGERS DR
    VICTORVILLE, CA
    ZIP 92394
  • Facility Phone: 760 952-7555
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLY VO
  • NPI Number: 1679853832
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2300342
LAB Type Pharmacy
Facility Name WALGREENS 12576
Street 15318 ROY RODGERS DR
City VICTORVILLE
State CA
ZIP 92394
Phone 760 952-7555
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 KELLY VO

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