05D0977224 CLIA NUMBER - RALPHS PHARMACY #210 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0977224
  • Facility Name: RALPHS PHARMACY #210 MOBILE CLIA
  • Facility Address: 11727 OLYMPIC BLVD
    LOS ANGELES, CA
    ZIP 90064
  • Facility Phone: 310 444-0603
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1942225545
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0977224
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #210 MOBILE CLIA
Street 11727 OLYMPIC BLVD
City LOS ANGELES
State CA
ZIP 90064
Phone 310 444-0603
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