14D0977146 CLIA NUMBER - KROGER PHARMACY J946

Laboratory Demographics

  • CLIA Code: 14D0977146
  • Facility Name: KROGER PHARMACY J946
  • Facility Address: 1818 S AIRPORT PLAZA
    DECATUR, IL
    ZIP 62525
  • Facility Phone: 217 864-5912
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEXANDRIA CASTRACANE
  • NPI Number: 1699848218
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0977146
LAB Type Pharmacy
Facility Name KROGER PHARMACY J946
Street 1818 S AIRPORT PLAZA
City DECATUR
State IL
ZIP 62525
Phone 217 864-5912
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Pharmacy
Lab Director ALEXANDRIA CASTRACANE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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