05D2301490 CLIA NUMBER - WALGREENS 11652

Laboratory Demographics

  • CLIA Code: 05D2301490
  • Facility Name: WALGREENS 11652
  • Facility Address: 1726 SUPERIOR AVE
    COSTA MESA, CA
    ZIP 92627
  • Facility Phone: 949 629-9714
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW H. TRAN
  • NPI Number: 1710351895
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2301490
LAB Type Pharmacy
Facility Name WALGREENS 11652
Street 1726 SUPERIOR AVE
City COSTA MESA
State CA
ZIP 92627
Phone 949 629-9714
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 ANDREW H. TRAN

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