05D0999606 CLIA NUMBER - RALPHS PHARMACY # 235 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0999606
  • Facility Name: RALPHS PHARMACY # 235 MOBILE CLIA
  • Facility Address: 659 E PALOMAR STREET
    CHULA VISTA, CA
    ZIP 91910
  • Facility Phone: 619 397-0466
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1710902317
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0999606
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 235 MOBILE CLIA
Street 659 E PALOMAR STREET
City CHULA VISTA
State CA
ZIP 91910
Phone 619 397-0466
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 MD

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