15D1076918 CLIA NUMBER - KROGER PHARMACY J71

Laboratory Demographics

CLIA Number: 15D1076918

Facility Name: KROGER PHARMACY J71

Facility Address:
2821 S WASHINGTON
KOKOMO, IN
ZIP 46902
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Facility Phone Number: 765 453-3173

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1548333065

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	15D1076918
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY J71
Street	2821 S WASHINGTON
City	KOKOMO
State	IN
ZIP	46902
Phone	765 453-3173
CertificateType	4
CertificateEffectiveDate	11/28/2023
CertificateExpirationDate	11/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024