15D1076915 CLIA NUMBER - KROGER PHARMACY J118

Laboratory Demographics

  • CLIA Code: 15D1076915
  • Facility Name: KROGER PHARMACY J118
  • Facility Address: 1930 E MAIN ST
    PLAINFIELD, IN
    ZIP 46168
  • Facility Phone: 317 893-5149
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIM FUHRMAN
  • NPI Number: 1760555387
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1076915
LAB Type Pharmacy
Facility Name KROGER PHARMACY J118
Street 1930 E MAIN ST
City PLAINFIELD
State IN
ZIP 46168
Phone 317 893-5149
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 TIM FUHRMAN

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