05D1027409 CLIA NUMBER - RALPHS PHARMACY #64 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D1027409
  • Facility Name: RALPHS PHARMACY #64 MOBILE CLIA
  • Facility Address: 14919 WHITTIER BLVD
    WHITTIER, CA
    ZIP 90605
  • Facility Phone: 562 945-5641
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1346265949
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1027409
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #64 MOBILE CLIA
Street 14919 WHITTIER BLVD
City WHITTIER
State CA
ZIP 90605
Phone 562 945-5641
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2024
Certificate Expiration Date 4/18/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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