15D1077284 CLIA NUMBER - KROGER PHARMACY J-886

Laboratory Demographics

  • CLIA Code: 15D1077284
  • Facility Name: KROGER PHARMACY J-886
  • Facility Address: 130 W HIVELY AVE
    ELKHART, IN
    ZIP 46517
  • Facility Phone: 574 294-6092
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALICIA LOVELY
  • NPI Number: 1841211653
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D1077284
LAB Type Pharmacy
Facility Name KROGER PHARMACY J-886
Street 130 W HIVELY AVE
City ELKHART
State IN
ZIP 46517
Phone 574 294-6092
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Pharmacy
Lab Director ALICIA LOVELY

Download Record

Download this CLIA record record in Text format: Export

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

Download this CLIA record record in XML format: Export

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