05D2307481 CLIA NUMBER - WALGREENS 12862

Laboratory Demographics

  • CLIA Code: 05D2307481
  • Facility Name: WALGREENS 12862
  • Facility Address: 12184 PALMDALE RD
    VICTORVILLE, CA
    ZIP 92392
  • Facility Phone: 760 561-7009
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID C. KISTNER
  • NPI Number: 1023431202
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2307481
LAB Type Pharmacy
Facility Name WALGREENS 12862
Street 12184 PALMDALE RD
City VICTORVILLE
State CA
ZIP 92392
Phone 760 561-7009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2024
Certificate Expiration Date 7/8/2026
Facility Type Pharmacy
Lab Director DAVID C. KISTNER

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