15D1029973 CLIA NUMBER - KROGER PHARMACY 966

Laboratory Demographics

  • CLIA Code: 15D1029973
  • Facility Name: KROGER PHARMACY 966
  • Facility Address: #55 PINE LAKE SHPS CTS
    LA PORTE, IN
    ZIP 46350
  • Facility Phone: 219 325-3152
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CAROLYN A. PERRA
  • NPI Number: 1558434860
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1029973
LAB Type Pharmacy
Facility Name KROGER PHARMACY 966
Street #55 PINE LAKE SHPS CTS
City LA PORTE
State IN
ZIP 46350
Phone 219 325-3152
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2024
Certificate Expiration Date 8/26/2026
Facility Type Pharmacy
Lab Director CAROLYN A. PERRA

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