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

Laboratory Demographics

CLIA Number: 14D1078264

Facility Name: KROGER PHARMACY J-943 THE KROGER COMPANY #21-943

Facility Address:
2507 E OAKLAND AVE
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 309 663-0423

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184797706

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024