05D2219107 CLIA NUMBER - INNOVATIVE COMPOUNDING INC DBA INNOVATIVE COMPOUNDING PHARMACY

Laboratory Demographics

  • CLIA Code: 05D2219107
  • Facility Name: INNOVATIVE COMPOUNDING INC DBA INNOVATIVE COMPOUNDING PHARMACY
  • Facility Address: 820 WALES DR
    FOLSOM, CA
    ZIP 95630
  • Facility Phone: 916 984-9222
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MASOUD RASHIDI
  • NPI Number: 1083829170
  • Taxonomy: 3336C0004X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2219107
LAB Type Pharmacy
Facility Name INNOVATIVE COMPOUNDING INC DBA INNOVATIVE COMPOUNDING PHARMACY
Street 820 WALES DR
City FOLSOM
State CA
ZIP 95630
Phone 916 984-9222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Pharmacy
Lab Director MASOUD RASHIDI

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