05D2184620 CLIA NUMBER - ST ANTONY PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2184620
  • Facility Name: ST ANTONY PHARMACY
  • Facility Address: 310 E GRAND AVE #405
    EL SEGUNDO, CA
    ZIP 90245
  • Facility Phone: 310 524-9244
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMAD MICHAEL
  • NPI Number: 1609822519
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2184620
LAB Type Pharmacy
Facility Name ST ANTONY PHARMACY
Street 310 E GRAND AVE #405
City EL SEGUNDO
State CA
ZIP 90245
Phone 310 524-9244
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Pharmacy
Lab Director EMAD MICHAEL

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