05D2188209 CLIA NUMBER - ACTIVE CARE PHARMACY INC DBA ACTIVE CARE PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2188209
  • Facility Name: ACTIVE CARE PHARMACY INC DBA ACTIVE CARE PHARMACY
  • Facility Address: 17050 BUSHARD STREET STE 300
    FOUNTAIN VALLEY, CA
    ZIP 92708
  • Facility Phone: 714 733-7930
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYRONE NGUYEN
  • NPI Number: 1477061745
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2188209
LAB Type Pharmacy
Facility Name ACTIVE CARE PHARMACY INC DBA ACTIVE CARE PHARMACY
Street 17050 BUSHARD STREET STE 300
City FOUNTAIN VALLEY
State CA
ZIP 92708
Phone 714 733-7930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Pharmacy
Lab Director TYRONE NGUYEN

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