05D2302493 CLIA NUMBER - WALGREENS 09844

Laboratory Demographics

  • CLIA Code: 05D2302493
  • Facility Name: WALGREENS 09844
  • Facility Address: 416 W OLIVE AVE
    PORTERVILLE, CA
    ZIP 93257
  • Facility Phone: 559 791-0104
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIEN Q. TONNU
  • NPI Number: 1508156852
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2302493
LAB Type Pharmacy
Facility Name WALGREENS 09844
Street 416 W OLIVE AVE
City PORTERVILLE
State CA
ZIP 93257
Phone 559 791-0104
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 TIEN Q. TONNU

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