05D2076726 CLIA NUMBER - VONS PHARMACY #2400

Laboratory Demographics

  • CLIA Code: 05D2076726
  • Facility Name: VONS PHARMACY #2400
  • Facility Address: 481 OLD MAMMOTH RD
    MAMMOTH LAKES, CA
    ZIP 93546
  • Facility Phone: 760 934-4337
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LIVIA X. WANG
  • NPI Number: 1871522821
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2076726
LAB Type Pharmacy
Facility Name VONS PHARMACY #2400
Street 481 OLD MAMMOTH RD
City MAMMOTH LAKES
State CA
ZIP 93546
Phone 760 934-4337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2024
Certificate Expiration Date 4/23/2026
Facility Type Pharmacy
Lab Director LIVIA X. WANG

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