14D2001124 CLIA NUMBER - KROGER PHARMACY #-642 THE KROGER CO

Laboratory Demographics

  • CLIA Code: 14D2001124
  • Facility Name: KROGER PHARMACY #-642 THE KROGER CO
  • Facility Address: 601 N COMMERCIAL ST, #3
    HARRISBURG, IL
    ZIP 62946
  • Facility Phone: (618) 252-8691
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1235163049
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2001124
LAB Type Pharmacy
Facility Name KROGER PHARMACY #-642 THE KROGER CO
Street 601 N COMMERCIAL ST, #3
City HARRISBURG
State IL
ZIP 62946
Phone 6182528691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2025
Certificate Expiration Date 12/13/2027
Facility Type Pharmacy
Lab Director PHELIRISIMA ROBERTS

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This page was last updated on: 5/18/2026