05D0977251 CLIA NUMBER - RALPHS PHARMACY #280 MOBILE CLIA

Laboratory Demographics

CLIA Number: 05D0977251

Facility Name: RALPHS PHARMACY #280 MOBILE CLIA

Facility Address:
4311 LINCOLN BLVD
MARINA DEL REY, CA
ZIP 90292
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Facility Phone Number: 310 821-4993

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1851316459

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D0977251
LAB Type	Pharmacy
Facility Name	RALPHS PHARMACY #280 MOBILE CLIA
Street	4311 LINCOLN BLVD
City	MARINA DEL REY
State	CA
ZIP	90292
Phone	310 821-4993
CertificateType	4
CertificateEffectiveDate	8/22/2022
CertificateExpirationDate	8/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024