05D0967406 CLIA NUMBER - BLYTHE MART PHARMACY

Laboratory Demographics

  • CLIA Code: 05D0967406
  • Facility Name: BLYTHE MART PHARMACY
  • Facility Address: 301 WEST HOBSONWAY
    BLYTHE, CA
    ZIP 92225
  • Facility Phone: 760 922-3511
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH G. LUCERO
  • NPI Number: 1811097652
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D0967406
LAB Type Pharmacy
Facility Name BLYTHE MART PHARMACY
Street 301 WEST HOBSONWAY
City BLYTHE
State CA
ZIP 92225
Phone 760 922-3511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Pharmacy
Lab Director KENNETH G. LUCERO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 9/29/2025