14D1078331 CLIA NUMBER - KROGER PHARMACY #917 THE KROGER COMPANY #21-917

Laboratory Demographics

  • CLIA Code: 14D1078331
  • Facility Name: KROGER PHARMACY #917 THE KROGER COMPANY #21-917
  • Facility Address: 801 W LAKE ST
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 682-2983
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATIE KAPELSON
  • NPI Number: 1508939125
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078331
LAB Type Pharmacy
Facility Name KROGER PHARMACY #917 THE KROGER COMPANY #21-917
Street 801 W LAKE ST
City PEORIA
State IL
ZIP 61614
Phone 309 682-2983
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type Pharmacy
Lab Director KATIE KAPELSON

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