05D2188430 CLIA NUMBER - LIFETIME VALUE PHARMACY III, INC

Laboratory Demographics

CLIA Number: 05D2188430

Facility Name: LIFETIME VALUE PHARMACY III, INC

Facility Address:
301 E 17TH ST
SANTA ANA, CA
ZIP 92706
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Facility Phone Number: 714 862-2470

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1407296742

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	05D2188430
LAB Type	Pharmacy
Facility Name	LIFETIME VALUE PHARMACY III, INC
Street	301 E 17TH ST
City	SANTA ANA
State	CA
ZIP	92706
Phone	714 862-2470
CertificateType	4
CertificateEffectiveDate	7/16/2022
CertificateExpirationDate	7/15/2024
FacilityType	Waiver

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