15D1077189 CLIA NUMBER - KROGER PHARMACY 927

Laboratory Demographics

  • CLIA Code: 15D1077189
  • Facility Name: KROGER PHARMACY 927
  • Facility Address: 4202 S EAST ST
    INDIANAPOLIS, IN
    ZIP 46227
  • Facility Phone: 317 781-4258
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. BUSUTTIL
  • NPI Number: 1487727798
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077189
LAB Type Pharmacy
Facility Name KROGER PHARMACY 927
Street 4202 S EAST ST
City INDIANAPOLIS
State IN
ZIP 46227
Phone 317 781-4258
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Pharmacy
Lab Director MICHAEL J. BUSUTTIL

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