15D1006754 CLIA NUMBER - KROGER PHARMACY #879

Laboratory Demographics

  • CLIA Code: 15D1006754
  • Facility Name: KROGER PHARMACY #879
  • Facility Address: 209 CHICAGO AVE
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 534-9223
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACIA STULTS
  • NPI Number: 1740353267
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1006754
LAB Type Pharmacy
Facility Name KROGER PHARMACY #879
Street 209 CHICAGO AVE
City GOSHEN
State IN
ZIP 46526
Phone 574 534-9223
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 STACIA STULTS

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