15D1077740 CLIA NUMBER - KROGER PHARMACY 138

Laboratory Demographics

  • CLIA Code: 15D1077740
  • Facility Name: KROGER PHARMACY 138
  • Facility Address: 916 N MAIN
    MONTICELLO, IN
    ZIP 47960
  • Facility Phone: 574 583-4489
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY RODKEY
  • NPI Number: 1376270165
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077740
LAB Type Pharmacy
Facility Name KROGER PHARMACY 138
Street 916 N MAIN
City MONTICELLO
State IN
ZIP 47960
Phone 574 583-4489
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Pharmacy
Lab Director MARY RODKEY

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