05D1052322 CLIA NUMBER - RALPHS PHARMACY # 645 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D1052322
  • Facility Name: RALPHS PHARMACY # 645 MOBILE CLIA
  • Facility Address: 500 N SEPULVEDA BLVD
    EL SEGUNDO, CA
    ZIP 90245
  • Facility Phone: 310 615-3025
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1073538674
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1052322
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 645 MOBILE CLIA
Street 500 N SEPULVEDA BLVD
City EL SEGUNDO
State CA
ZIP 90245
Phone 310 615-3025
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

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