15D1037185 CLIA NUMBER - KROGER PHARMACY 972

Laboratory Demographics

  • CLIA Code: 15D1037185
  • Facility Name: KROGER PHARMACY 972
  • Facility Address: 601 E DUPONT RD
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 637-6115
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TERI BRAASCH
  • NPI Number: 1669545976
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1037185
LAB Type Pharmacy
Facility Name KROGER PHARMACY 972
Street 601 E DUPONT RD
City FORT WAYNE
State IN
ZIP 46825
Phone 260 637-6115
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 TERI BRAASCH

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