05D2057149 CLIA NUMBER - VONS PHARMACY #1753

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Laboratory Demographics

CLIA Number: 05D2057149

Facility Name: VONS PHARMACY #1753

Facility Address:
1190 N MAIN ST
BISHOP, CA
ZIP 93514
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Facility Phone Number: 760 872-8114

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1851320881

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D2057149
LAB Type	Pharmacy
Facility Name	VONS PHARMACY #1753
Street	1190 N MAIN ST
City	BISHOP
State	CA
ZIP	93514
Phone	760 872-8114
CertificateType	4
CertificateEffectiveDate	4/10/2023
CertificateExpirationDate	4/9/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024