05D0987392 CLIA NUMBER - RALPHS PHARMACY #207 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0987392
  • Facility Name: RALPHS PHARMACY #207 MOBILE CLIA
  • Facility Address: 4315 MISSION BLVD
    PACIFIC BEACH, CA
    ZIP 92109
  • Facility Phone: 858 273-2108
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1023033628
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0987392
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #207 MOBILE CLIA
Street 4315 MISSION BLVD
City PACIFIC BEACH
State CA
ZIP 92109
Phone 858 273-2108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2025
Certificate Expiration Date 6/3/2027
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC MD

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