05D2307671 CLIA NUMBER - WALGREENS 11365

Laboratory Demographics

  • CLIA Code: 05D2307671
  • Facility Name: WALGREENS 11365
  • Facility Address: 210 AMERICAN CANYON RD
    AMERICAN CANYON, CA
    ZIP 94503
  • Facility Phone: 707 557-0103
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CATHERINE M. NICOLAS
  • NPI Number: 1912294364
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2307671
LAB Type Pharmacy
Facility Name WALGREENS 11365
Street 210 AMERICAN CANYON RD
City AMERICAN CANYON
State CA
ZIP 94503
Phone 707 557-0103
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Pharmacy
Lab Director CATHERINE M. NICOLAS

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