05D0999604 CLIA NUMBER - RALPHS PHARMACY # 604 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0999604
  • Facility Name: RALPHS PHARMACY # 604 MOBILE CLIA
  • Facility Address: 12470 SEAL BEACH BLVD
    SEAL BEACH, CA
    ZIP 90740
  • Facility Phone: 562 598-2734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1629093224
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0999604
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 604 MOBILE CLIA
Street 12470 SEAL BEACH BLVD
City SEAL BEACH
State CA
ZIP 90740
Phone 562 598-2734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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