05D2199164 CLIA NUMBER - SAN JOSE SPECIALTY CARE SURGERY

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Laboratory Demographics

CLIA Number: 05D2199164

Facility Name: SAN JOSE SPECIALTY CARE SURGERY

Facility Address:
150 N JACKSON AVE STE 107
SAN JOSE, CA
ZIP 95116
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Facility Phone Number: 951 734-7246

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1952532194

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	05D2199164
LAB Type	Physician Office
Facility Name	SAN JOSE SPECIALTY CARE SURGERY
Street	150 N JACKSON AVE STE 107
City	SAN JOSE
State	CA
ZIP	95116
Phone	951 734-7246
CertificateType	4
CertificateEffectiveDate	11/5/2022
CertificateExpirationDate	11/4/2024
FacilityType	Waiver

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