14D1078264 CLIA NUMBER - KROGER PHARMACY J-943 THE KROGER COMPANY #21-943

Laboratory Demographics

  • CLIA Code: 14D1078264
  • Facility Name: KROGER PHARMACY J-943 THE KROGER COMPANY #21-943
  • Facility Address: 2507 E OAKLAND AVE
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 663-0423
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRENDA BROY
  • NPI Number: 1184797706
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078264
LAB Type Physician Office
Facility Name KROGER PHARMACY J-943 THE KROGER COMPANY #21-943
Street 2507 E OAKLAND AVE
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 663-0423
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Physician Office
Lab Director BRENDA BROY

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