05D2308937 CLIA NUMBER - WALGREENS 05555

Laboratory Demographics

  • CLIA Code: 05D2308937
  • Facility Name: WALGREENS 05555
  • Facility Address: 550 S RIVERSIDE AVE
    RIALTO, CA
    ZIP 92376
  • Facility Phone: 909 874-6700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM L. SHANNON
  • NPI Number: 1225044886
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2308937
LAB Type Pharmacy
Facility Name WALGREENS 05555
Street 550 S RIVERSIDE AVE
City RIALTO
State CA
ZIP 92376
Phone 909 874-6700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2024
Certificate Expiration Date 8/5/2026
Facility Type Pharmacy
Lab Director KIM L. SHANNON

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