05D2302320 CLIA NUMBER - WALGREENS 09254

Laboratory Demographics

  • CLIA Code: 05D2302320
  • Facility Name: WALGREENS 09254
  • Facility Address: 13655 BEAR VALLEY RD
    VICTORVILLE, CA
    ZIP 92392
  • Facility Phone: 760 949-8930
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IDA WHITE
  • NPI Number: 1508871518
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302320
LAB Type Pharmacy
Facility Name WALGREENS 09254
Street 13655 BEAR VALLEY RD
City VICTORVILLE
State CA
ZIP 92392
Phone 760 949-8930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2024
Certificate Expiration Date 4/8/2026
Facility Type Pharmacy
Lab Director IDA WHITE

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