05D2302487 CLIA NUMBER - WALGREENS 12419

Laboratory Demographics

  • CLIA Code: 05D2302487
  • Facility Name: WALGREENS 12419
  • Facility Address: 11795 W OLYMPIC BLVD
    LOS ANGELES, CA
    ZIP 90064
  • Facility Phone: 310 312-6506
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHADI T. ALAGHEHBANDZADEH
  • NPI Number: 1720311327
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302487
LAB Type Pharmacy
Facility Name WALGREENS 12419
Street 11795 W OLYMPIC BLVD
City LOS ANGELES
State CA
ZIP 90064
Phone 310 312-6506
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2024
Certificate Expiration Date 4/9/2026
Facility Type Pharmacy
Lab Director SHADI T. ALAGHEHBANDZADEH

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