05D0573388 CLIA NUMBER - KAISER FOUNDATION HOSPITAL FONTANA LABORATORY

Laboratory Demographics

CLIA Number: 05D0573388

Facility Name: KAISER FOUNDATION HOSPITAL FONTANA LABORATORY

Facility Address:
9961 SIERRA AVE ROOM 1208
FONTANA, CA
ZIP 92335
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Facility Phone Number: (909) 302-8075

Facility Type: HEALTH MAINTENANCE ORGANIZATION

Certificate Type: Accreditation

NPI Number: 1962568238

Taxonomy: 3336C0004X - Pharmacy
A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.

CLIA Record

Field Name	Field Value
CLIA Number	05D0573388
LAB Type	HEALTH MAINTENANCE ORGANIZATION
Facility Name	KAISER FOUNDATION HOSPITAL FONTANA LABORATORY
Street	9961 SIERRA AVE ROOM 1208
City	FONTANA
State	CA
ZIP	92335
Phone	(909) 302-8075

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This page was last updated on: 5/11/2023