05D2300343 CLIA NUMBER - WALGREENS 12548

Laboratory Demographics

  • CLIA Code: 05D2300343
  • Facility Name: WALGREENS 12548
  • Facility Address: 1130 FOXWORTHY AVE
    SAN JOSE, CA
    ZIP 95118
  • Facility Phone: 408 723-9905
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIRIAM CRAFT
  • NPI Number: 1891701298
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2300343
LAB Type Pharmacy
Facility Name WALGREENS 12548
Street 1130 FOXWORTHY AVE
City SAN JOSE
State CA
ZIP 95118
Phone 408 723-9905
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 MIRIAM CRAFT

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