05D2110002 CLIA NUMBER - 986 PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2110002
  • Facility Name: 986 PHARMACY
  • Facility Address: 2143 FOOTHILL BLVD
    LA VERNE, CA
    ZIP 91750
  • Facility Phone: 909 596-6168
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: YANG XU
  • NPI Number: 1245604792
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2110002
LAB Type Pharmacy
Facility Name 986 PHARMACY
Street 2143 FOOTHILL BLVD
City LA VERNE
State CA
ZIP 91750
Phone 909 596-6168
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Pharmacy
Lab Director YANG XU

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