05D2300811 CLIA NUMBER - WALGREENS 02434

Laboratory Demographics

  • CLIA Code: 05D2300811
  • Facility Name: WALGREENS 02434
  • Facility Address: 1830 W 11TH ST
    TRACY, CA
    ZIP 95376
  • Facility Phone: 209 832-1498
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY U. NGUYEN
  • NPI Number: 1255346524
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2300811
LAB Type Pharmacy
Facility Name WALGREENS 02434
Street 1830 W 11TH ST
City TRACY
State CA
ZIP 95376
Phone 209 832-1498
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2024
Certificate Expiration Date 3/14/2026
Facility Type Pharmacy
Lab Director AMY U. NGUYEN

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