15D1077255 CLIA NUMBER - KROGER PHARMACY 00874

Laboratory Demographics

  • CLIA Code: 15D1077255
  • Facility Name: KROGER PHARMACY 00874
  • Facility Address: 621 COUNTRYSIDE DR
    COLUMBIA CITY, IN
    ZIP 46725
  • Facility Phone: 260 248-4572
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIMPAL CHAUDHARI
  • NPI Number: 1003989526
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077255
LAB Type Pharmacy
Facility Name KROGER PHARMACY 00874
Street 621 COUNTRYSIDE DR
City COLUMBIA CITY
State IN
ZIP 46725
Phone 260 248-4572
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director DIMPAL CHAUDHARI

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