14D1078329 CLIA NUMBER - KROGER PHARMACY 924

Laboratory Demographics

  • CLIA Code: 14D1078329
  • Facility Name: KROGER PHARMACY 924
  • Facility Address: 255 W 1ST DRIVE
    DECATUR, IL
    ZIP 62521
  • Facility Phone: (217) 428-1778
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACY DOYLE
  • NPI Number: 1699848218
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078329
LAB Type Pharmacy
Facility Name KROGER PHARMACY 924
Street 255 W 1ST DRIVE
City DECATUR
State IL
ZIP 62521
Phone 2174281778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2026
Certificate Expiration Date 1/7/2028
Facility Type Pharmacy
Lab Director STACY DOYLE

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This page was last updated on: 5/18/2026