05D2269705 CLIA NUMBER - PAVILIONS PHARMACY #2412

Laboratory Demographics

  • CLIA Code: 05D2269705
  • Facility Name: PAVILIONS PHARMACY #2412
  • Facility Address: 3901 PORTOLA PKWY
    IRVINE, CA
    ZIP 92602
  • Facility Phone: 657 273-5755
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY HSIEH
  • NPI Number: 1750817870
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2269705
LAB Type Pharmacy
Facility Name PAVILIONS PHARMACY #2412
Street 3901 PORTOLA PKWY
City IRVINE
State CA
ZIP 92602
Phone 657 273-5755
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Pharmacy
Lab Director MARY HSIEH

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