05D2057143 CLIA NUMBER - VONS PHARMACY #2131

Laboratory Demographics

  • CLIA Code: 05D2057143
  • Facility Name: VONS PHARMACY #2131
  • Facility Address: 12199 HESPERIA RD
    VICTORVILLE, CA
    ZIP 92392
  • Facility Phone: 760 241-8384
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN E. BOTTORFF
  • NPI Number: 1356387963
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2057143
LAB Type Pharmacy
Facility Name VONS PHARMACY #2131
Street 12199 HESPERIA RD
City VICTORVILLE
State CA
ZIP 92392
Phone 760 241-8384
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Pharmacy
Lab Director STEPHEN E. BOTTORFF

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