05D0977298 CLIA NUMBER - RALPHS PHARMACY #756 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0977298
  • Facility Name: RALPHS PHARMACY #756 MOBILE CLIA
  • Facility Address: 710 N ROSE DR
    PLACENTIA, CA
    ZIP 92870
  • Facility Phone: 714 524-6200
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1831114438
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0977298
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #756 MOBILE CLIA
Street 710 N ROSE DR
City PLACENTIA
State CA
ZIP 92870
Phone 714 524-6200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2024
Certificate Expiration Date 8/22/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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This page was last updated on: 3/20/2025