05D2301443 CLIA NUMBER - WALGREENS 11990

Laboratory Demographics

  • CLIA Code: 05D2301443
  • Facility Name: WALGREENS 11990
  • Facility Address: 9728 WINTER GARDENS BLVD
    LAKESIDE, CA
    ZIP 92040
  • Facility Phone: 619 938-0069
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEA C. EVANGELISTA
  • NPI Number: 1306075890
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2301443
LAB Type Pharmacy
Facility Name WALGREENS 11990
Street 9728 WINTER GARDENS BLVD
City LAKESIDE
State CA
ZIP 92040
Phone 619 938-0069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2024
Certificate Expiration Date 3/25/2026
Facility Type Pharmacy
Lab Director LEA C. EVANGELISTA

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