14D1076415 CLIA NUMBER - KROGER PHARMACY J-984

Laboratory Demographics

  • CLIA Code: 14D1076415
  • Facility Name: KROGER PHARMACY J-984
  • Facility Address: 633 ARMOUR RD
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 815 935-1653
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELIZABETH SCHIFF
  • NPI Number: 1407042120
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Pharmacy
Lab Director ELIZABETH SCHIFF

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