05D2301954 CLIA NUMBER - WALGREENS 13161

Laboratory Demographics

  • CLIA Code: 05D2301954
  • Facility Name: WALGREENS 13161
  • Facility Address: 4029 43RD ST
    SAN DIEGO, CA
    ZIP 92105
  • Facility Phone: 619 521-9753
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHELLY PALO
  • NPI Number: 1316227572
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2301954
LAB Type Pharmacy
Facility Name WALGREENS 13161
Street 4029 43RD ST
City SAN DIEGO
State CA
ZIP 92105
Phone 619 521-9753
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Pharmacy
Lab Director SHELLY PALO

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