15D1033466 CLIA NUMBER - KROGER PHARMACY J 962

Laboratory Demographics

  • CLIA Code: 15D1033466
  • Facility Name: KROGER PHARMACY J 962
  • Facility Address: 5025 W 71ST ST
    INDIANAPOLIS, IN
    ZIP 46268
  • Facility Phone: (317) 347-8488
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEILANIE RIVERA FORES
  • NPI Number: 1578636882
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D1033466
LAB Type Pharmacy
Facility Name KROGER PHARMACY J 962
Street 5025 W 71ST ST
City INDIANAPOLIS
State IN
ZIP 46268
Phone 3173478488
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2024
Certificate Expiration Date 11/8/2026
Facility Type Pharmacy
Lab Director LEILANIE RIVERA FORES

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: 5/15/2026