05D2003150 CLIA NUMBER - RALPHS PHARMACY # 16 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D2003150
  • Facility Name: RALPHS PHARMACY # 16 MOBILE CLIA
  • Facility Address: 670 S WESTERN AVE
    LOS ANGELES, CA
    ZIP 90005
  • Facility Phone: 213 383-6207
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC
  • NPI Number: 1144386418
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2003150
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 16 MOBILE CLIA
Street 670 S WESTERN AVE
City LOS ANGELES
State CA
ZIP 90005
Phone 213 383-6207
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2024
Certificate Expiration Date 2/2/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC

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