05D0549005 CLIA NUMBER - VENICE FAMILY CLINIC

Laboratory Demographics

CLIA Number: 05D0549005

Facility Name: VENICE FAMILY CLINIC

Facility Address:
604 ROSE AVENUE
VENICE, CA
ZIP 90291
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Facility Phone Number: 310 664-7803

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1982154308

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D0549005
LAB Type	Community Clinic
Facility Name	VENICE FAMILY CLINIC
Street	604 ROSE AVENUE
City	VENICE
State	CA
ZIP	90291
Phone	310 664-7803
CertificateType	3
CertificateEffectiveDate	8/14/2023
CertificateExpirationDate	8/13/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024