05D1038877 CLIA NUMBER - SAV ON PHARMACY #4563

Laboratory Demographics

  • CLIA Code: 05D1038877
  • Facility Name: SAV ON PHARMACY #4563
  • Facility Address: 989 AVENIDA PICO
    SAN CLEMENTE, CA
    ZIP 92673
  • Facility Phone: 949 369-5596
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIMON TO, RPH
  • NPI Number: 1154377521
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1038877
LAB Type Pharmacy
Facility Name SAV ON PHARMACY #4563
Street 989 AVENIDA PICO
City SAN CLEMENTE
State CA
ZIP 92673
Phone 949 369-5596
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director SIMON TO, RPH

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