15D1012627 CLIA NUMBER - KROGER PHARMACY 21-974

Laboratory Demographics

  • CLIA Code: 15D1012627
  • Facility Name: KROGER PHARMACY 21-974
  • Facility Address: 1601 E MICHIGAN RD
    SHELBYVILLE, IN
    ZIP 46176
  • Facility Phone: 317 421-2356
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE THOMAS
  • NPI Number: 1184797607
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1012627
LAB Type Pharmacy
Facility Name KROGER PHARMACY 21-974
Street 1601 E MICHIGAN RD
City SHELBYVILLE
State IN
ZIP 46176
Phone 317 421-2356
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2025
Certificate Expiration Date 5/15/2027
Facility Type Pharmacy
Lab Director KYLE THOMAS

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