50D2053412 CLIA NUMBER - SAFEWAY PHARMACY 1472

Laboratory Demographics

  • CLIA Code: 50D2053412
  • Facility Name: SAFEWAY PHARMACY 1472
  • Facility Address: 315 E COLLEGE WAY
    MOUNT VERNON, WA
    ZIP 98273
  • Facility Phone: 360 424-0467
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN TEGART
  • NPI Number: 1487690095
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2053412
LAB Type Pharmacy
Facility Name SAFEWAY PHARMACY 1472
Street 315 E COLLEGE WAY
City MOUNT VERNON
State WA
ZIP 98273
Phone 360 424-0467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2013
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