15D0974066 CLIA NUMBER - KROGER PHARMACY J902

Laboratory Demographics

  • CLIA Code: 15D0974066
  • Facility Name: KROGER PHARMACY J902
  • Facility Address: 930 W MAIN ST
    PERU, IN
    ZIP 46970
  • Facility Phone: (765) 473-2076
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTINA VAN METER
  • NPI Number: 1093888513
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D0974066
LAB Type Pharmacy
Facility Name KROGER PHARMACY J902
Street 930 W MAIN ST
City PERU
State IN
ZIP 46970
Phone 7654732076
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director CHRISTINA VAN METER

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