14D2000593 CLIA NUMBER - KROGER PHARMACY L-714 THE KROGER COMPANY

Laboratory Demographics

  • CLIA Code: 14D2000593
  • Facility Name: KROGER PHARMACY L-714 THE KROGER COMPANY
  • Facility Address: 501 N GIANT CITY RD
    CARBONDALE, IL
    ZIP 62902
  • Facility Phone: 618 549-9743
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1225062037
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2000593
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-714 THE KROGER COMPANY
Street 501 N GIANT CITY RD
City CARBONDALE
State IL
ZIP 62902
Phone 618 549-9743
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

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