15D0926172 CLIA NUMBER - KROGER PHARMACY J 940

Laboratory Demographics

  • CLIA Code: 15D0926172
  • Facility Name: KROGER PHARMACY J 940
  • Facility Address: 2420 N LEBANON ST
    LEBANON, IN
    ZIP 46052
  • Facility Phone: 765 482-7095
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAN S. POTTER
  • NPI Number: 1114090735
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D0926172
LAB Type Pharmacy
Facility Name KROGER PHARMACY J 940
Street 2420 N LEBANON ST
City LEBANON
State IN
ZIP 46052
Phone 765 482-7095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Pharmacy
Lab Director JAN S. POTTER

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