05D2303815 CLIA NUMBER - WALGREENS 09716

Laboratory Demographics

  • CLIA Code: 05D2303815
  • Facility Name: WALGREENS 09716
  • Facility Address: 102 N JACK TONE RD # R
    RIPON, CA
    ZIP 95366
  • Facility Phone: 209 599-1639
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEPH BASTA
  • NPI Number: 1912010497
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2303815
LAB Type Pharmacy
Facility Name WALGREENS 09716
Street 102 N JACK TONE RD # R
City RIPON
State CA
ZIP 95366
Phone 209 599-1639
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2024
Certificate Expiration Date 4/30/2026
Facility Type Pharmacy
Lab Director JOSEPH BASTA

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