14D1078332 CLIA NUMBER - KROGER PHARMACY #922

Laboratory Demographics

  • CLIA Code: 14D1078332
  • Facility Name: KROGER PHARMACY #922
  • Facility Address: 3070 N WATER STREET
    DECATUR, IL
    ZIP 62526
  • Facility Phone: 217 877-1327
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT P. DAVIS
  • NPI Number: 1992878516
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078332
LAB Type Pharmacy
Facility Name KROGER PHARMACY #922
Street 3070 N WATER STREET
City DECATUR
State IL
ZIP 62526
Phone 217 877-1327
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 ROBERT P. DAVIS

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