15D1077197 CLIA NUMBER - KROGER PHARMACY #929

Laboratory Demographics

  • CLIA Code: 15D1077197
  • Facility Name: KROGER PHARMACY #929
  • Facility Address: 218 E PETTIT
    FORT WAYNE, IN
    ZIP 46806
  • Facility Phone: 260 456-4736
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT WAGNER
  • NPI Number: 1679646293
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077197
LAB Type Pharmacy
Facility Name KROGER PHARMACY #929
Street 218 E PETTIT
City FORT WAYNE
State IN
ZIP 46806
Phone 260 456-4736
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 ROBERT WAGNER

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