05D2302160 CLIA NUMBER - WALGREENS 12913

Laboratory Demographics

  • CLIA Code: 05D2302160
  • Facility Name: WALGREENS 12913
  • Facility Address: 1500 E GAGE AVE
    LOS ANGELES, CA
    ZIP 90001
  • Facility Phone: 323 581-0964
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON TRAN
  • NPI Number: 1356659932
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302160
LAB Type Pharmacy
Facility Name WALGREENS 12913
Street 1500 E GAGE AVE
City LOS ANGELES
State CA
ZIP 90001
Phone 323 581-0964
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 JASON TRAN

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