05D1052315 CLIA NUMBER - RALPHS PHARMACY # 213 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D1052315
  • Facility Name: RALPHS PHARMACY # 213 MOBILE CLIA
  • Facility Address: 22915 VICTORY BLVD
    WEST HILLS, CA
    ZIP 91307
  • Facility Phone: 818 716-1275
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1164447769
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1052315
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 213 MOBILE CLIA
Street 22915 VICTORY BLVD
City WEST HILLS
State CA
ZIP 91307
Phone 818 716-1275
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC MD

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This page was last updated on: 6/4/2025