05D2155695 CLIA NUMBER - VILLA PARK PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2155695
  • Facility Name: VILLA PARK PHARMACY
  • Facility Address: 17821 SANTIAGO BLVD
    VILLA PARK, CA
    ZIP 92861
  • Facility Phone: 714 998-3030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADAM BOLLENBACH
  • NPI Number: 1497891766
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2155695
LAB Type Pharmacy
Facility Name VILLA PARK PHARMACY
Street 17821 SANTIAGO BLVD
City VILLA PARK
State CA
ZIP 92861
Phone 714 998-3030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Pharmacy
Lab Director ADAM BOLLENBACH

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