05D0987439 CLIA NUMBER - RALPHS PHARMACY #704 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0987439
  • Facility Name: RALPHS PHARMACY #704 MOBILE CLIA
  • Facility Address: 16940 DEVONSHIRE ST
    GRANADA HILLS, CA
    ZIP 91344
  • Facility Phone: 818 831-4962
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC, MD
  • NPI Number: 1396760997
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0987439
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #704 MOBILE CLIA
Street 16940 DEVONSHIRE ST
City GRANADA HILLS
State CA
ZIP 91344
Phone 818 831-4962
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC, MD

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