15D1076910 CLIA NUMBER - KROGER PHARMACY J-110

Laboratory Demographics

  • CLIA Code: 15D1076910
  • Facility Name: KROGER PHARMACY J-110
  • Facility Address: 3361 KENTUCKY AVE
    INDIANAPOLIS, IN
    ZIP 46221
  • Facility Phone: 317 240-1588
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA LOCKE
  • NPI Number: 1114090636
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1076910
LAB Type Pharmacy
Facility Name KROGER PHARMACY J-110
Street 3361 KENTUCKY AVE
City INDIANAPOLIS
State IN
ZIP 46221
Phone 317 240-1588
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2023
Certificate Expiration Date 11/27/2025
Facility Type Pharmacy
Lab Director MELISSA LOCKE

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