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05D2269705 CLIA NUMBER - PAVILIONS PHARMACY #2412

Laboratory Demographics

CLIA Number: 05D2269705

Facility Name: PAVILIONS PHARMACY #2412

Facility Address:
3901 PORTOLA PKWY
IRVINE, CA
ZIP 92602
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Facility Phone Number: 657 273-5755

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1750817870

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 05D2269705
LAB Type Pharmacy
Facility Name PAVILIONS PHARMACY #2412
Street 3901 PORTOLA PKWY
City IRVINE
State CA
ZIP 92602
Phone 657 273-5755
CertificateType 4
CertificateEffectiveDate 9/30/2022
CertificateExpirationDate 9/29/2024
FacilityType Waiver

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