05D2183485 CLIA NUMBER - MTM PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2183485
  • Facility Name: MTM PHARMACY
  • Facility Address: 12666 BROOKHURST ST STE 110
    GARDEN GROVE, CA
    ZIP 92840
  • Facility Phone: 714 705-6992
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TUYET QUACH
  • NPI Number: 1659797421
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2183485
LAB Type Pharmacy
Facility Name MTM PHARMACY
Street 12666 BROOKHURST ST STE 110
City GARDEN GROVE
State CA
ZIP 92840
Phone 714 705-6992
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/6/2024
Certificate Expiration Date 5/5/2026
Facility Type Pharmacy
Lab Director TUYET QUACH

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