15D0979091 CLIA NUMBER - KROGER PHARMACY #862

Laboratory Demographics

  • CLIA Code: 15D0979091
  • Facility Name: KROGER PHARMACY #862
  • Facility Address: 11101 PENDLETON PIKE
    INDIANAPOLIS, IN
    ZIP 46236
  • Facility Phone: 317 823-3245
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAMI JADE WYLY
  • NPI Number: 1629141148
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D0979091
LAB Type Pharmacy
Facility Name KROGER PHARMACY #862
Street 11101 PENDLETON PIKE
City INDIANAPOLIS
State IN
ZIP 46236
Phone 317 823-3245
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director TAMI JADE WYLY

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