05D2302490 CLIA NUMBER - WALGREENS 09780

Laboratory Demographics

  • CLIA Code: 05D2302490
  • Facility Name: WALGREENS 09780
  • Facility Address: 15480 MAIN ST
    HESPERIA, CA
    ZIP 92345
  • Facility Phone: 760 947-2283
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY HUANG
  • NPI Number: 1407891351
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302490
LAB Type Pharmacy
Facility Name WALGREENS 09780
Street 15480 MAIN ST
City HESPERIA
State CA
ZIP 92345
Phone 760 947-2283
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 AMY HUANG

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