14D1078246 CLIA NUMBER - KROGER PHARMACY L-380

Laboratory Demographics

  • CLIA Code: 14D1078246
  • Facility Name: KROGER PHARMACY L-380
  • Facility Address: 1704 W DEYOUNG ST
    MARION, IL
    ZIP 62959
  • Facility Phone: 618 993-6518
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1144254954
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078246
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-380
Street 1704 W DEYOUNG ST
City MARION
State IL
ZIP 62959
Phone 618 993-6518
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Pharmacy
Lab Director PHELIRISIMA ROBERTS

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