05D2308182 CLIA NUMBER - WALGREENS 10467

Laboratory Demographics

  • CLIA Code: 05D2308182
  • Facility Name: WALGREENS 10467
  • Facility Address: 1236 N WATERMAN AVE
    SAN BERNARDINO, CA
    ZIP 92404
  • Facility Phone: 909 885-7146
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TUONG LE
  • NPI Number: 1417149089
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2308182
LAB Type Pharmacy
Facility Name WALGREENS 10467
Street 1236 N WATERMAN AVE
City SAN BERNARDINO
State CA
ZIP 92404
Phone 909 885-7146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Pharmacy
Lab Director TUONG LE

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