05D2309634 CLIA NUMBER - EISNER PEDIATRIC & FAMILY MEDICAL CENTER PHARMACY

Laboratory Demographics

CLIA Code: 05D2309634
Facility Name: EISNER PEDIATRIC & FAMILY MEDICAL CENTER PHARMACY
Facility Address: 1500 S OLIVE ST RM# 101
LOS ANGELES, CA
ZIP 90015
Facility Phone: 213 747-5542
Facility Type: Pharmacy
Facility Type: Waiver
Lab Director: NICOLE M. TAVARES-KUHN
NPI Number: 1477336543
Taxonomy: 390200000X - Student in an Organized Health Care Education/Training Program

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CLIA Record

Field Name	Field Value
CLIA Number	05D2309634
LAB Type	Pharmacy
Facility Name	EISNER PEDIATRIC & FAMILY MEDICAL CENTER PHARMACY
Street	1500 S OLIVE ST RM# 101
City	LOS ANGELES
State	CA
ZIP	90015
Phone	213 747-5542
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	8/19/2024
Certificate Expiration Date	8/18/2026
Facility Type	Pharmacy
Lab Director	NICOLE M. TAVARES-KUHN

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This page was last updated on: 3/20/2025