05D2089423 CLIA NUMBER - OPTIMAL WELLNESS PHARMACY

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Laboratory Demographics

CLIA Number: 05D2089423

Facility Name: OPTIMAL WELLNESS PHARMACY

Facility Address:
4200 TRABUCO RD STE 190
IRVINE, CA
ZIP 92620
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Facility Phone Number: 949 949-8613

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1518374156

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	05D2089423
LAB Type	Pharmacy
Facility Name	OPTIMAL WELLNESS PHARMACY
Street	4200 TRABUCO RD STE 190
City	IRVINE
State	CA
ZIP	92620
Phone	949 949-8613
CertificateType	4
CertificateEffectiveDate	12/30/2022
CertificateExpirationDate	12/29/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024