15D0970449 CLIA NUMBER - KROGER PHARMACY J921

Laboratory Demographics

  • CLIA Code: 15D0970449
  • Facility Name: KROGER PHARMACY J921
  • Facility Address: 530 S INDIANA ST
    MOORESVILLE, IN
    ZIP 46158
  • Facility Phone: 317 831-9416
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEBRA N. COHEN
  • NPI Number: 1457424970
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D0970449
LAB Type Pharmacy
Facility Name KROGER PHARMACY J921
Street 530 S INDIANA ST
City MOORESVILLE
State IN
ZIP 46158
Phone 317 831-9416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2024
Certificate Expiration Date 2/14/2026
Facility Type Pharmacy
Lab Director DEBRA N. COHEN

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