05D2235032 CLIA NUMBER - ARCHANA CORPORATION DBA LEO'S LAKESIDE PHARMACY

Laboratory Demographics

CLIA Number: 05D2235032

Facility Name: ARCHANA CORPORATION DBA LEO'S LAKESIDE PHARMACY

Facility Address:
9943 MAINE AVE
LAKESIDE, CA
ZIP 92040
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Facility Phone Number: 619 443-1013

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1013589100

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	05D2235032
LAB Type	Pharmacy
Facility Name	ARCHANA CORPORATION DBA LEO'S LAKESIDE PHARMACY
Street	9943 MAINE AVE
City	LAKESIDE
State	CA
ZIP	92040
Phone	619 443-1013
CertificateType	4
CertificateEffectiveDate	9/7/2023
CertificateExpirationDate	9/6/2025
FacilityType	Waiver

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