14D1076415 CLIA NUMBER - KROGER PHARMACY J-984

Laboratory Demographics

CLIA Number: 14D1076415

Facility Name: KROGER PHARMACY J-984

Facility Address:
633 ARMOUR RD
BOURBONNAIS, IL
ZIP 60914
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Facility Phone Number: 815 935-1653

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1407042120

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D1076415
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY J-984
Street	633 ARMOUR RD
City	BOURBONNAIS
State	IL
ZIP	60914
Phone	815 935-1653
CertificateType	4
CertificateEffectiveDate	6/25/2022
CertificateExpirationDate	6/24/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024