14D1078330 CLIA NUMBER - KROGER PHARMACY #942

Laboratory Demographics

  • CLIA Code: 14D1078330
  • Facility Name: KROGER PHARMACY #942
  • Facility Address: 3311 N STERLING AVE
    PEORIA, IL
    ZIP 61604
  • Facility Phone: 309 679-2855
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LINDA M. SEWELL-WILSON
  • NPI Number: 1710050331
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078330
LAB Type Pharmacy
Facility Name KROGER PHARMACY #942
Street 3311 N STERLING AVE
City PEORIA
State IL
ZIP 61604
Phone 309 679-2855
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director LINDA M. SEWELL-WILSON

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