05D2155695 CLIA NUMBER - VILLA PARK PHARMACY

Laboratory Demographics

CLIA Number: 05D2155695

Facility Name: VILLA PARK PHARMACY

Facility Address:
17821 SANTIAGO BLVD
VILLA PARK, CA
ZIP 92861
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Facility Phone Number: 714 998-3030

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1497891766

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	05D2155695
LAB Type	Pharmacy
Facility Name	VILLA PARK PHARMACY
Street	17821 SANTIAGO BLVD
City	VILLA PARK
State	CA
ZIP	92861
Phone	714 998-3030
CertificateType	4
CertificateEffectiveDate	10/3/2022
CertificateExpirationDate	10/2/2024
FacilityType	Waiver

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