05D2057149 CLIA NUMBER - VONS PHARMACY #1753

Laboratory Demographics

  • CLIA Code: 05D2057149
  • Facility Name: VONS PHARMACY #1753
  • Facility Address: 1190 N MAIN ST
    BISHOP, CA
    ZIP 93514
  • Facility Phone: 760 872-8114
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LIVIA WANG
  • NPI Number: 1851320881
  • Taxonomy: 3336C0003X - Pharmacy

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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
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 LIVIA WANG

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