05D2057830 CLIA NUMBER - PAVILIONS PHARMACY #1911

Laboratory Demographics

  • CLIA Code: 05D2057830
  • Facility Name: PAVILIONS PHARMACY #1911
  • Facility Address: 21181 NEWPORT COAST DR
    NEWPORT COAST, CA
    ZIP 92657
  • Facility Phone: 949 718-4986
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NERMINE EID
  • NPI Number: 1396781167
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2057830
LAB Type Pharmacy
Facility Name PAVILIONS PHARMACY #1911
Street 21181 NEWPORT COAST DR
City NEWPORT COAST
State CA
ZIP 92657
Phone 949 718-4986
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Pharmacy
Lab Director NERMINE EID

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