05D1027405 CLIA NUMBER - RALPHS PHARMACY #611

Laboratory Demographics

  • CLIA Code: 05D1027405
  • Facility Name: RALPHS PHARMACY #611
  • Facility Address: 425 S SUNRISE WAY STE A
    PALM SPRINGS, CA
    ZIP 92262
  • Facility Phone: (760) 327-4381
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1619992211
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1027405
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #611
Street 425 S SUNRISE WAY STE A
City PALM SPRINGS
State CA
ZIP 92262
Phone 7603274381
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2024
Certificate Expiration Date 6/28/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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This page was last updated on: 5/18/2026