05D2004469 CLIA NUMBER - RALPHS PHARMACY # 99 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D2004469
  • Facility Name: RALPHS PHARMACY # 99 MOBILE CLIA
  • Facility Address: 26751 PORTOLA PARKWAY
    FOOTHILL RANCH, CA
    ZIP 92610
  • Facility Phone: 949 457-0690
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC, MD
  • NPI Number: 1154346757
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2004469
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 99 MOBILE CLIA
Street 26751 PORTOLA PARKWAY
City FOOTHILL RANCH
State CA
ZIP 92610
Phone 949 457-0690
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC, MD

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