05D1052325 CLIA NUMBER - RALPHS PHARMACY # 45 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D1052325
  • Facility Name: RALPHS PHARMACY # 45 MOBILE CLIA
  • Facility Address: 12660 LIMONITE AVE
    CORONA, CA
    ZIP 92880
  • Facility Phone: 951 734-8678
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC, MD
  • NPI Number: 1336164938
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1052325
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 45 MOBILE CLIA
Street 12660 LIMONITE AVE
City CORONA
State CA
ZIP 92880
Phone 951 734-8678
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2025
Certificate Expiration Date 5/23/2027
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC, MD

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