50D1034880 CLIA NUMBER - SAFEWAY PHARMACY 419

Laboratory Demographics

  • CLIA Code: 50D1034880
  • Facility Name: SAFEWAY PHARMACY 419
  • Facility Address: 370 SW SEDGWICK RD
    PORT ORCHARD, WA
    ZIP 98367
  • Facility Phone: 360 876-2698
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN M. TEGART
  • NPI Number: 1205882826
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D1034880
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY 419
Street 370 SW SEDGWICK RD
City PORT ORCHARD
State WA
ZIP 98367
Phone 360 876-2698
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2004
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SUSAN M. TEGART

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