05D2058087 CLIA NUMBER - VONS PHARMACY # 2091

Laboratory Demographics

  • CLIA Code: 05D2058087
  • Facility Name: VONS PHARMACY # 2091
  • Facility Address: 32401 CAMINO CAPISTRANO
    SAN JUAN CAPISTRANO, CA
    ZIP 92675
  • Facility Phone: 949 661-3492
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH J. WAHLSTROM
  • NPI Number: 1326084922
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2058087
LAB Type Pharmacy
Facility Name VONS PHARMACY # 2091
Street 32401 CAMINO CAPISTRANO
City SAN JUAN CAPISTRANO
State CA
ZIP 92675
Phone 949 661-3492
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 KENNETH J. WAHLSTROM

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This page was last updated on: 6/4/2025