05D0999612 CLIA NUMBER - RALPHS PHARMACY #683 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D0999612
  • Facility Name: RALPHS PHARMACY #683 MOBILE CLIA
  • Facility Address: 306 TWIN OAKS VALLEY RD
    SAN MARCOS, CA
    ZIP 92078
  • Facility Phone: 760 891-0618
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1992720593
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D0999612
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #683 MOBILE CLIA
Street 306 TWIN OAKS VALLEY RD
City SAN MARCOS
State CA
ZIP 92078
Phone 760 891-0618
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