14D0923589 CLIA NUMBER - KROGER PHARMACY

Laboratory Demographics

  • CLIA Code: 14D0923589
  • Facility Name: KROGER PHARMACY
  • Facility Address: 1550 E COLLEGE AVE
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 452-0839
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW LAYMAN
  • NPI Number: 1629141247
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D0923589
LAB Type Pharmacy
Facility Name KROGER PHARMACY
Street 1550 E COLLEGE AVE
City NORMAL
State IL
ZIP 61761
Phone 309 452-0839
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2025
Certificate Expiration Date 1/6/2027
Facility Type Pharmacy
Lab Director MATTHEW LAYMAN

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