15D1037184 CLIA NUMBER - KROGER PHARMACY 928

Laboratory Demographics

  • CLIA Code: 15D1037184
  • Facility Name: KROGER PHARMACY 928
  • Facility Address: 1175 COLLEGE MALL RD
    BLOOMINGTON, IN
    ZIP 47401
  • Facility Phone: 812 333-5760
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMILY S. BRENNEMAN
  • NPI Number: 1215000831
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1037184
LAB Type Pharmacy
Facility Name KROGER PHARMACY 928
Street 1175 COLLEGE MALL RD
City BLOOMINGTON
State IN
ZIP 47401
Phone 812 333-5760
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2025
Certificate Expiration Date 2/16/2027
Facility Type Pharmacy
Lab Director EMILY S. BRENNEMAN

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