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05D0913814 CLIA NUMBER - CORAM HEALTHCARE CORP OF SOUTHERN CALIFORNIA DBA CORAM CVS/SPECIALTY INFUSION SERVICES

Laboratory Demographics

CLIA Number: 05D0913814

Facility Name: CORAM HEALTHCARE CORP OF SOUTHERN CALIFORNIA DBA CORAM CVS/SPECIALTY INFUSION SERVICES

Facility Address:
4355 E LOWELL ST STE C
ONTARIO, CA
ZIP 91761
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Facility Phone Number: 909 605-1230

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1740239623

Taxonomy: 3336H0001X - Pharmacy
Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance.

CLIA Record

Field Name Field Value
CLIA Number 05D0913814
LAB Type Pharmacy
Facility Name CORAM HEALTHCARE CORP OF SOUTHERN CALIFORNIA DBA CORAM CVS/SPECIALTY INFUSION SERVICES
Street 4355 E LOWELL ST STE C
City ONTARIO
State CA
ZIP 91761
Phone 909 605-1230
CertificateType 4
CertificateEffectiveDate 4/11/2024
CertificateExpirationDate 4/10/2026
FacilityType Waiver

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