14D1012126 CLIA NUMBER - KROGER PHARMACY J705

Laboratory Demographics

  • CLIA Code: 14D1012126
  • Facility Name: KROGER PHARMACY J705
  • Facility Address: 201 SOUTH MAIN
    EAST PEORIA, IL
    ZIP 61611
  • Facility Phone: 309 694-6451
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL KOWALENKO
  • NPI Number: 1275606899
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1012126
LAB Type Pharmacy
Facility Name KROGER PHARMACY J705
Street 201 SOUTH MAIN
City EAST PEORIA
State IL
ZIP 61611
Phone 309 694-6451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2025
Certificate Expiration Date 4/30/2027
Facility Type Pharmacy
Lab Director DANIEL KOWALENKO

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