05D1052320 CLIA NUMBER - RALPHS PHARMACY #84

Laboratory Demographics

  • CLIA Code: 05D1052320
  • Facility Name: RALPHS PHARMACY #84
  • Facility Address: 29675 THE OLD ROAD NORTH
    CASTAIC, CA
    ZIP 91384
  • Facility Phone: 661 702-6936
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1790700391
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1052320
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #84
Street 29675 THE OLD ROAD NORTH
City CASTAIC
State CA
ZIP 91384
Phone 661 702-6936
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC MD

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