14D1097217 CLIA NUMBER - KROGER PHARMACY L-746

Laboratory Demographics

  • CLIA Code: 14D1097217
  • Facility Name: KROGER PHARMACY L-746
  • Facility Address: 1609 S PARK AVE
    HERRIN, IL
    ZIP 62948
  • Facility Phone: 618 988-1649
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1598799306
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D1097217
LAB Type Industrial
Facility Name KROGER PHARMACY L-746
Street 1609 S PARK AVE
City HERRIN
State IL
ZIP 62948
Phone 618 988-1649
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Industrial
Lab Director PHELIRISIMA ROBERTS

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