15D1076916 CLIA NUMBER - KROGER PHARMACY 920

Laboratory Demographics

  • CLIA Code: 15D1076916
  • Facility Name: KROGER PHARMACY 920
  • Facility Address: 120 S MEMORIAL DR
    NEW CASTLE, IN
    ZIP 47362
  • Facility Phone: 765 521-7379
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CRAIG SIMMONS
  • NPI Number: 1770656399
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1076916
LAB Type Pharmacy
Facility Name KROGER PHARMACY 920
Street 120 S MEMORIAL DR
City NEW CASTLE
State IN
ZIP 47362
Phone 765 521-7379
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 CRAIG SIMMONS

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