05D1046264 CLIA NUMBER - KAISER FOUNDATION HOSPITAL MANTECA

Laboratory Demographics

CLIA Number: 05D1046264

Facility Name: KAISER FOUNDATION HOSPITAL MANTECA

Facility Address:
1777 WEST YOSEMITE AVE
MANTECA, CA
ZIP 95337
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Facility Phone Number: 209 735-6552

Facility Type: Hospital

Certificate Type: Microscopy

NPI Number: 1649327958

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D1046264
LAB Type	Hospital
Facility Name	KAISER FOUNDATION HOSPITAL MANTECA
Street	1777 WEST YOSEMITE AVE
City	MANTECA
State	CA
ZIP	95337
Phone	209 735-6552
CertificateType	3
CertificateEffectiveDate	10/4/2023
CertificateExpirationDate	10/3/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024