05D2302145 CLIA NUMBER - WALGREENS 12549

Laboratory Demographics

  • CLIA Code: 05D2302145
  • Facility Name: WALGREENS 12549
  • Facility Address: 2040 E MARIPOSA RD
    STOCKTON, CA
    ZIP 95205
  • Facility Phone: 209 465-4167
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KULBIR K. DHATT
  • NPI Number: 1649526682
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302145
LAB Type Pharmacy
Facility Name WALGREENS 12549
Street 2040 E MARIPOSA RD
City STOCKTON
State CA
ZIP 95205
Phone 209 465-4167
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 KULBIR K. DHATT

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