05D2307677 CLIA NUMBER - WALGREENS 10768

Laboratory Demographics

  • CLIA Code: 05D2307677
  • Facility Name: WALGREENS 10768
  • Facility Address: 11121 SIERRA AVE
    FONTANA, CA
    ZIP 92337
  • Facility Phone: 909 356-9715
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANNIE HSIEH
  • NPI Number: 1689812794
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2307677
LAB Type Pharmacy
Facility Name WALGREENS 10768
Street 11121 SIERRA AVE
City FONTANA
State CA
ZIP 92337
Phone 909 356-9715
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 ANNIE HSIEH

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