05D0975515 CLIA NUMBER - RALPHS PHARMACY #720

Laboratory Demographics

  • CLIA Code: 05D0975515
  • Facility Name: RALPHS PHARMACY #720
  • Facility Address: 30019 HAWTHORNE BLVD
    RANCHO PALOS VERDES, CA
    ZIP 90275
  • Facility Phone: 310 377-6829
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1538184130
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0975515
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #720
Street 30019 HAWTHORNE BLVD
City RANCHO PALOS VERDES
State CA
ZIP 90275
Phone 310 377-6829
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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