05D2307294 CLIA NUMBER - WALGREENS 04491

Laboratory Demographics

  • CLIA Code: 05D2307294
  • Facility Name: WALGREENS 04491
  • Facility Address: 15650 SAN PABLO AVE
    SAN PABLO, CA
    ZIP 94806
  • Facility Phone: 510 243-1100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS A. BENZSCHAWEL
  • NPI Number: 1942215215
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2307294
LAB Type Pharmacy
Facility Name WALGREENS 04491
Street 15650 SAN PABLO AVE
City SAN PABLO
State CA
ZIP 94806
Phone 510 243-1100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/5/2024
Certificate Expiration Date 7/4/2026
Facility Type Pharmacy
Lab Director NICHOLAS A. BENZSCHAWEL

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