50D2010723 CLIA NUMBER - SAFEWAY PHARMACY #0494

Laboratory Demographics

  • CLIA Code: 50D2010723
  • Facility Name: SAFEWAY PHARMACY #0494
  • Facility Address: 152 ROOSEVELT AVE
    ENUMCLAW, WA
    ZIP 98022
  • Facility Phone: 360 802-1534
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN TEGART
  • NPI Number: 1003842881
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2010723
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY #0494
Street 152 ROOSEVELT AVE
City ENUMCLAW
State WA
ZIP 98022
Phone 360 802-1534
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2013
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SUSAN TEGART

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