14D1076963 CLIA NUMBER - KROGER PHARMACY J-923

Laboratory Demographics

  • CLIA Code: 14D1076963
  • Facility Name: KROGER PHARMACY J-923
  • Facility Address: 1607 BROADWAY
    PEKIN, IL
    ZIP 61554
  • Facility Phone: 309 353-5333
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AUGUST W. DUEZ
  • NPI Number: 1457424079
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1076963
LAB Type Pharmacy
Facility Name KROGER PHARMACY J-923
Street 1607 BROADWAY
City PEKIN
State IL
ZIP 61554
Phone 309 353-5333
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 AUGUST W. DUEZ

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