05D2060320 CLIA NUMBER - RALPHS PHARMACY #105 MOBILE CLIA

Laboratory Demographics

  • CLIA Code: 05D2060320
  • Facility Name: RALPHS PHARMACY #105 MOBILE CLIA
  • Facility Address: 10525 4S COMMONS DR.
    SAN DIEGO, CA
    ZIP 92127
  • Facility Phone: 858 675-7028
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH PATRIC, MD
  • NPI Number: 1235296583
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2060320
LAB Type Pharmacy
Facility Name RALPHS PHARMACY #105 MOBILE CLIA
Street 10525 4S COMMONS DR.
City SAN DIEGO
State CA
ZIP 92127
Phone 858 675-7028
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type Pharmacy
Lab Director KENNETH PATRIC, MD

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