05D2058059 CLIA NUMBER - VONS PHARMACY #2502

Laboratory Demographics

  • CLIA Code: 05D2058059
  • Facility Name: VONS PHARMACY #2502
  • Facility Address: 500 E MANCHESTER BLVD
    INGLEWOOD, CA
    ZIP 90301
  • Facility Phone: 310 677-0501
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GARY LAI
  • NPI Number: 1447289467
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058059
LAB Type Pharmacy
Facility Name VONS PHARMACY #2502
Street 500 E MANCHESTER BLVD
City INGLEWOOD
State CA
ZIP 90301
Phone 310 677-0501
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Pharmacy
Lab Director GARY LAI

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