05D2322089 CLIA NUMBER - LIFETIME PHARMACY CORP

Laboratory Demographics

  • CLIA Code: 05D2322089
  • Facility Name: LIFETIME PHARMACY CORP
  • Facility Address: 23080 ALESSANDRO BLVD, #212
    MORENO VALLEY, CA
    ZIP 92553
  • Facility Phone: 951 656-7171
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADA J. VANDYKE
  • NPI Number: 1558512848
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 05D2322089
LAB Type Pharmacy
Facility Name LIFETIME PHARMACY CORP
Street 23080 ALESSANDRO BLVD, #212
City MORENO VALLEY
State CA
ZIP 92553
Phone 951 656-7171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Pharmacy
Lab Director ADA J. VANDYKE

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