14D1078341 CLIA NUMBER - KROGER PHARMACY J-531

Laboratory Demographics

  • CLIA Code: 14D1078341
  • Facility Name: KROGER PHARMACY J-531
  • Facility Address: 1405 W GARFIELD
    BARTONVILLE, IL
    ZIP 61607
  • Facility Phone: 317 579-8434
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LESLIE VONDERHAAR
  • NPI Number: 1871666495
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078341
LAB Type Pharmacy
Facility Name KROGER PHARMACY J-531
Street 1405 W GARFIELD
City BARTONVILLE
State IL
ZIP 61607
Phone 317 579-8434
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 LESLIE VONDERHAAR

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