05D2307105 CLIA NUMBER - WALGREENS 09183

Laboratory Demographics

  • CLIA Code: 05D2307105
  • Facility Name: WALGREENS 09183
  • Facility Address: 1301 W BASE LINE ST
    SAN BERNARDINO, CA
    ZIP 92411
  • Facility Phone: 909 386-5724
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMBER M. MORA
  • NPI Number: 1699780601
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2307105
LAB Type Pharmacy
Facility Name WALGREENS 09183
Street 1301 W BASE LINE ST
City SAN BERNARDINO
State CA
ZIP 92411
Phone 909 386-5724
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2024
Certificate Expiration Date 6/30/2026
Facility Type Pharmacy
Lab Director AMBER M. MORA

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