Healther Providers Data Logo

15D1077170 CLIA NUMBER - KROGER PHARMACY 109

Laboratory Demographics

CLIA Number: 15D1077170

Facility Name: KROGER PHARMACY 109

Facility Address:
605 N DIXON RD
KOKOMO, IN
ZIP 46901
Get Directions

Facility Phone Number: 765 451-0800

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1205909827

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 15D1077170
LAB Type Pharmacy
Facility Name KROGER PHARMACY 109
Street 605 N DIXON RD
City KOKOMO
State IN
ZIP 46901
Phone 765 451-0800
CertificateType 4
CertificateEffectiveDate 12/4/2023
CertificateExpirationDate 12/3/2025
FacilityType Waiver

Download Record

Download this CLIA NUMBER record in Text format: Export

Download this CLIA NUMBER record in Excel (CSV) format: Export

Download this CLIA NUMBER record in XML format: Export

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