05D0610000 CLIA NUMBER - KAISER FOUNDATION HOSPITAL MANTECA LABORATORY

Laboratory Demographics

CLIA Number: 05D0610000

Facility Name: KAISER FOUNDATION HOSPITAL MANTECA LABORATORY

Facility Address:
1777 W YOSEMITE AVE
MANTECA, CA
ZIP 95337
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Facility Phone Number: 209 735-6508

Facility Type: Hospital

Certificate Type: Accreditation

NPI Number: 1649327958

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	05D0610000
LAB Type	Hospital
Facility Name	KAISER FOUNDATION HOSPITAL MANTECA LABORATORY
Street	1777 W YOSEMITE AVE
City	MANTECA
State	CA
ZIP	95337
Phone	209 735-6508
CertificateType	1
CertificateEffectiveDate	2/28/2023
CertificateExpirationDate	2/27/2025
FacilityType	Accreditation

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