05D1067896 CLIA NUMBER - VONS PHARMACY #1621

Laboratory Demographics

  • CLIA Code: 05D1067896
  • Facility Name: VONS PHARMACY #1621
  • Facility Address: 520 W TEFFT ST
    NIPOMO, CA
    ZIP 93444
  • Facility Phone: 805 931-1860
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHANNES D. BEUKES
  • NPI Number: 1982633905
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1067896
LAB Type Pharmacy
Facility Name VONS PHARMACY #1621
Street 520 W TEFFT ST
City NIPOMO
State CA
ZIP 93444
Phone 805 931-1860
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Pharmacy
Lab Director JOHANNES D. BEUKES

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