05D0714179 CLIA NUMBER - GARDENA MEDICAL GROUP

Laboratory Demographics

CLIA Number: 05D0714179

Facility Name: GARDENA MEDICAL GROUP

Facility Address:
1146 W REDONDO BEACH BLVD
GARDENA, CA
ZIP 90247
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Facility Phone Number: 310 323-9999

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003851320

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	05D0714179
LAB Type	Physician Office
Facility Name	GARDENA MEDICAL GROUP
Street	1146 W REDONDO BEACH BLVD
City	GARDENA
State	CA
ZIP	90247
Phone	310 323-9999
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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