05D0977246 CLIA NUMBER - RALPHS PHARMACY #196 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0977246
  • Facility Name: RALPHS PHARMACY #196 MOBILE CLIA
  • Facility Address: 2250 E CARSON ST
    LONG BEACH, CA
    ZIP 90807
  • Facility Phone: 562 490-0201
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1043239189
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0977246
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #196 MOBILE CLIA
Street 2250 E CARSON ST
City LONG BEACH
State CA
ZIP 90807
Phone 562 490-0201
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