05D1011109 CLIA NUMBER - RALPHS PHARMACY #118 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D1011109
  • Facility Name: RALPHS PHARMACY #118 MOBILE CLIA
  • Facility Address: 23801 WASHINGTON AVE
    MURRIETA, CA
    ZIP 92562
  • Facility Phone: 951 600-8639
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1083639686
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1011109
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #118 MOBILE CLIA
Street 23801 WASHINGTON AVE
City MURRIETA
State CA
ZIP 92562
Phone 951 600-8639
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC MD

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