05D2057148 CLIA NUMBER - VONS PHARMACY #1767

Laboratory Demographics

  • CLIA Code: 05D2057148
  • Facility Name: VONS PHARMACY #1767
  • Facility Address: 475 W MAIN ST
    BRAWLEY, CA
    ZIP 92227
  • Facility Phone: 760 351-3007
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DOMINGA M. DE VERA
  • NPI Number: 1134158181
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2057148
LAB Type Pharmacy
Facility Name VONS PHARMACY #1767
Street 475 W MAIN ST
City BRAWLEY
State CA
ZIP 92227
Phone 760 351-3007
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 DOMINGA M. DE VERA

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