05D2057152 CLIA NUMBER - VONS PHARMACY# 1623

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Laboratory Demographics

CLIA Number: 05D2057152

Facility Name: VONS PHARMACY# 1623

Facility Address:
4001 INGLEWOOD AVE
REDONDO BEACH, CA
ZIP 90278
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Facility Phone Number: 310 349-0863

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1699711200

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	05D2057152
LAB Type	Pharmacy
Facility Name	VONS PHARMACY# 1623
Street	4001 INGLEWOOD AVE
City	REDONDO BEACH
State	CA
ZIP	90278
Phone	310 349-0863
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