05D2003009 CLIA NUMBER - RALPHS PHARMACY #201

Laboratory Demographics

  • CLIA Code: 05D2003009
  • Facility Name: RALPHS PHARMACY #201
  • Facility Address: 3345 SPORTS ARENA BLVD
    SAN DIEGO, CA
    ZIP 92110
  • Facility Phone: 619 222-5818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1629086830
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2003009
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #201
Street 3345 SPORTS ARENA BLVD
City SAN DIEGO
State CA
ZIP 92110
Phone 619 222-5818
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

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