05D2003001 CLIA NUMBER - RALPHS PHARMACY #113 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D2003001
  • Facility Name: RALPHS PHARMACY #113 MOBILE CLIA
  • Facility Address: 16225 SIERRA LAKES PKWY
    FONTANA, CA
    ZIP 92336
  • Facility Phone: 909 357-2525
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC MD
  • NPI Number: 1871650127
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2003001
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #113 MOBILE CLIA
Street 16225 SIERRA LAKES PKWY
City FONTANA
State CA
ZIP 92336
Phone 909 357-2525
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2024
Certificate Expiration Date 1/28/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC MD

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