15D1034688 CLIA NUMBER - KROGER PHARMACY 969

Laboratory Demographics

  • CLIA Code: 15D1034688
  • Facility Name: KROGER PHARMACY 969
  • Facility Address: 11700 OLIO ROAD
    FISHERS, IN
    ZIP 46038
  • Facility Phone: 317 598-8515
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS MATHSON
  • NPI Number: 1528131042
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1034688
LAB Type Pharmacy
Facility Name KROGER PHARMACY 969
Street 11700 OLIO ROAD
City FISHERS
State IN
ZIP 46038
Phone 317 598-8515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Pharmacy
Lab Director THOMAS MATHSON

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