14D2000586 CLIA NUMBER - KROGER PHARMACY L-672 THE KROGER COMPANY

Laboratory Demographics

  • CLIA Code: 14D2000586
  • Facility Name: KROGER PHARMACY L-672 THE KROGER COMPANY
  • Facility Address: 45 PLAZA DR
    ANNA, IL
    ZIP 62906
  • Facility Phone: 618 833-4521
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1407880214
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2000586
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-672 THE KROGER COMPANY
Street 45 PLAZA DR
City ANNA
State IL
ZIP 62906
Phone 618 833-4521
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Pharmacy
Lab Director PHELIRISIMA ROBERTS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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