05D1011110 CLIA NUMBER - RALPHS PHARMACY #21

Laboratory Demographics

  • CLIA Code: 05D1011110
  • Facility Name: RALPHS PHARMACY #21
  • Facility Address: 1745 GARFIELD AVE
    SOUTH PASADENA, CA
    ZIP 91030
  • Facility Phone: 626 799-2926
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1265457865
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1011110
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #21
Street 1745 GARFIELD AVE
City SOUTH PASADENA
State CA
ZIP 91030
Phone 626 799-2926
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

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