15D0972400 CLIA NUMBER - KROGER PHARMACY J-096

Laboratory Demographics

  • CLIA Code: 15D0972400
  • Facility Name: KROGER PHARMACY J-096
  • Facility Address: 202 S MAIN ST
    RUSHVILLE, IN
    ZIP 46173
  • Facility Phone: 765 938-3155
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRAZI BAKER
  • NPI Number: 1639242159
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D0972400
LAB Type Pharmacy
Facility Name KROGER PHARMACY J-096
Street 202 S MAIN ST
City RUSHVILLE
State IN
ZIP 46173
Phone 765 938-3155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2024
Certificate Expiration Date 4/4/2026
Facility Type Pharmacy
Lab Director TRAZI BAKER

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