05D1067938 CLIA NUMBER - VONS PHARMACY #2688

Laboratory Demographics

  • CLIA Code: 05D1067938
  • Facility Name: VONS PHARMACY #2688
  • Facility Address: 6170 HAMNER AVE
    MIRA LOMA, CA
    ZIP 91752
  • Facility Phone: 951 360-1911
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEREK O. LA
  • NPI Number: 1083643027
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D1067938
LAB Type Pharmacy
Facility Name VONS PHARMACY #2688
Street 6170 HAMNER AVE
City MIRA LOMA
State CA
ZIP 91752
Phone 951 360-1911
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 DEREK O. LA

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