05D2058086 CLIA NUMBER - PAVILIONS PHARMACY 2229

Laboratory Demographics

  • CLIA Code: 05D2058086
  • Facility Name: PAVILIONS PHARMACY 2229
  • Facility Address: 727 N VINE ST
    LOS ANGELES, CA
    ZIP 90038
  • Facility Phone: 323 466-7158
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER T. HO
  • NPI Number: 1184660797
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058086
LAB Type Pharmacy
Facility Name PAVILIONS PHARMACY 2229
Street 727 N VINE ST
City LOS ANGELES
State CA
ZIP 90038
Phone 323 466-7158
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 JENNIFER T. HO

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