15D1077778 CLIA NUMBER - KROGER PHARMACY 990

Laboratory Demographics

  • CLIA Code: 15D1077778
  • Facility Name: KROGER PHARMACY 990
  • Facility Address: 5725 COVENTRY LN
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: (260) 434-0497
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA MUNDT
  • NPI Number: 1346421088
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 15D1077778
LAB Type Pharmacy
Facility Name KROGER PHARMACY 990
Street 5725 COVENTRY LN
City FORT WAYNE
State IN
ZIP 46804
Phone 2604340497
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2025
Certificate Expiration Date 12/18/2027
Facility Type Pharmacy
Lab Director ANDREA MUNDT

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This page was last updated on: 5/18/2026