15D1021822 CLIA NUMBER - KROGER PHARMACY 907

Laboratory Demographics

CLIA Number: 15D1021822

Facility Name: KROGER PHARMACY 907

Facility Address:
1600 S OHIO ST
MARTINSVILLE, IN
ZIP 46151
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Facility Phone Number: 765 342-6213

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1295808715

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 15D1021822
LAB Type Pharmacy
Facility Name KROGER PHARMACY 907
Street 1600 S OHIO ST
City MARTINSVILLE
State IN
ZIP 46151
Phone 765 342-6213
CertificateType 4
CertificateEffectiveDate 2/2/2024
CertificateExpirationDate 2/1/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024