05D2303493 CLIA NUMBER - WALGREENS 09534

Laboratory Demographics

  • CLIA Code: 05D2303493
  • Facility Name: WALGREENS 09534
  • Facility Address: 15990 BROOKHURST ST
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 775-3974
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HOANG NGUYEN
  • NPI Number: 1679758692
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2303493
LAB Type Pharmacy
Facility Name WALGREENS 09534
Street 15990 BROOKHURST ST
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 775-3974
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2024
Certificate Expiration Date 4/24/2026
Facility Type Pharmacy
Lab Director HOANG NGUYEN

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