05D0977199 CLIA NUMBER - RALPHS PHARMACY #72

Laboratory Demographics

  • CLIA Code: 05D0977199
  • Facility Name: RALPHS PHARMACY #72
  • Facility Address: 1121 N HARBOR BLVD
    FULLERTON, CA
    ZIP 92832
  • Facility Phone: 714 992-6313
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1477578078
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0977199
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #72
Street 1121 N HARBOR BLVD
City FULLERTON
State CA
ZIP 92832
Phone 714 992-6313
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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