05D2008933 CLIA NUMBER - RALPHS PHARMACY # 650 MOBILE CLIA ,

Laboratory Demographics

  • CLIA Code: 05D2008933
  • Facility Name: RALPHS PHARMACY # 650 MOBILE CLIA ,
  • Facility Address: 19081 GOLDEN WEST ST
    HUNTINGTON BEACH, CA
    ZIP 92648
  • Facility Phone: 714 960-3102
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH W. PATRIC, MD
  • NPI Number: 1710200027
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2008933
LAB Type Pharmacy
Facility Name RALPHS PHARMACY # 650 MOBILE CLIA ,
Street 19081 GOLDEN WEST ST
City HUNTINGTON BEACH
State CA
ZIP 92648
Phone 714 960-3102
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2024
Certificate Expiration Date 6/21/2026
Facility Type Pharmacy
Lab Director KENNETH W. PATRIC, MD

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This page was last updated on: 3/20/2025