14D1078906 CLIA NUMBER - KROGER PHARMACY 677

Laboratory Demographics

  • CLIA Code: 14D1078906
  • Facility Name: KROGER PHARMACY 677
  • Facility Address: 603 SOUTH 4TH STREET
    CHILLICOTHE, IL
    ZIP 61523
  • Facility Phone: 309 274-3419
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARC STUIVE
  • NPI Number: 1780757302
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1078906
LAB Type Pharmacy
Facility Name KROGER PHARMACY 677
Street 603 SOUTH 4TH STREET
City CHILLICOTHE
State IL
ZIP 61523
Phone 309 274-3419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Pharmacy
Lab Director MARC STUIVE

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