05D2057683 CLIA NUMBER - VONS PHARMACY #3017

Laboratory Demographics

  • CLIA Code: 05D2057683
  • Facility Name: VONS PHARMACY #3017
  • Facility Address: 3027 RANCHO VISTA BLVD
    PALMDALE, CA
    ZIP 93551
  • Facility Phone: 661 575-2333
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NERMINE IBRAHIM
  • NPI Number: 1144266750
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2057683
LAB Type Pharmacy
Facility Name VONS PHARMACY #3017
Street 3027 RANCHO VISTA BLVD
City PALMDALE
State CA
ZIP 93551
Phone 661 575-2333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Pharmacy
Lab Director NERMINE IBRAHIM

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