14D2092711 CLIA NUMBER - KROGER PHARMACY #704

Laboratory Demographics

  • CLIA Code: 14D2092711
  • Facility Name: KROGER PHARMACY #704
  • Facility Address: 2701 N COLUMBUS
    OTTAWA, IL
    ZIP 61350
  • Facility Phone: 000 815-4341
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARAH MATHIEU
  • NPI Number: 1538232152
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2092711
LAB Type Pharmacy
Facility Name KROGER PHARMACY #704
Street 2701 N COLUMBUS
City OTTAWA
State IL
ZIP 61350
Phone 000 815-4341
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2025
Certificate Expiration Date 3/10/2027
Facility Type Pharmacy
Lab Director SARAH MATHIEU

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