05D2302141 CLIA NUMBER - WALGREENS 12528

Laboratory Demographics

  • CLIA Code: 05D2302141
  • Facility Name: WALGREENS 12528
  • Facility Address: 475 STATE HIGHWAY 49
    SUTTER CREEK, CA
    ZIP 95685
  • Facility Phone: 209 267-5128
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICHARD M. LA
  • NPI Number: 1316263726
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302141
LAB Type Pharmacy
Facility Name WALGREENS 12528
Street 475 STATE HIGHWAY 49
City SUTTER CREEK
State CA
ZIP 95685
Phone 209 267-5128
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2024
Certificate Expiration Date 4/3/2026
Facility Type Pharmacy
Lab Director RICHARD M. LA

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