05D0999607 CLIA NUMBER - RALPHS PHARMACY STORE 160

Laboratory Demographics

  • CLIA Code: 05D0999607
  • Facility Name: RALPHS PHARMACY STORE 160
  • Facility Address: 49908 JEFFERSON STREET
    INDIO, CA
    ZIP 92201
  • Facility Phone: 760 771-4524
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1134148273
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0999607
LAB Type Pharmacy
Facility Name RALPHS PHARMACY STORE 160
Street 49908 JEFFERSON STREET
City INDIO
State CA
ZIP 92201
Phone 760 771-4524
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