14D1076959 CLIA NUMBER - KROGER PHARMACY 657

Laboratory Demographics

  • CLIA Code: 14D1076959
  • Facility Name: KROGER PHARMACY 657
  • Facility Address: #20 CHERRY TREE SHPG CTR
    WASHINGTON, IL
    ZIP 61571
  • Facility Phone: 309 886-2408
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEATHER M. KHALI
  • NPI Number: 1316010937
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1076959
LAB Type Pharmacy
Facility Name KROGER PHARMACY 657
Street #20 CHERRY TREE SHPG CTR
City WASHINGTON
State IL
ZIP 61571
Phone 309 886-2408
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2023
Certificate Expiration Date 11/27/2025
Facility Type Pharmacy
Lab Director HEATHER M. KHALI

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