05D2304186 CLIA NUMBER - WALGREENS 05498

Laboratory Demographics

  • CLIA Code: 05D2304186
  • Facility Name: WALGREENS 05498
  • Facility Address: 3500 COFFEE RD
    MODESTO, CA
    ZIP 95355
  • Facility Phone: 209 341-0814
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOC P. LE
  • NPI Number: 1760498331
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2304186
LAB Type Pharmacy
Facility Name WALGREENS 05498
Street 3500 COFFEE RD
City MODESTO
State CA
ZIP 95355
Phone 209 341-0814
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Pharmacy
Lab Director LOC P. LE

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