05D1067929 CLIA NUMBER - VONS PHARMACY #2335

Laboratory Demographics

  • CLIA Code: 05D1067929
  • Facility Name: VONS PHARMACY #2335
  • Facility Address: 2684 N TUSTIN STREET
    ORANGE, CA
    ZIP 92865
  • Facility Phone: 714 637-2140
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMIE KO
  • NPI Number: 1518996552
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1067929
LAB Type Pharmacy
Facility Name VONS PHARMACY #2335
Street 2684 N TUSTIN STREET
City ORANGE
State CA
ZIP 92865
Phone 714 637-2140
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 JAMIE KO

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