15D1077788 CLIA NUMBER - KROGER PHARMACY J900

Laboratory Demographics

  • CLIA Code: 15D1077788
  • Facility Name: KROGER PHARMACY J900
  • Facility Address: 4025 S OLD SR 37
    BLOOMINGTON, IN
    ZIP 47401
  • Facility Phone: 812 824-5205
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAURA JONES
  • NPI Number: 1013080324
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077788
LAB Type Pharmacy
Facility Name KROGER PHARMACY J900
Street 4025 S OLD SR 37
City BLOOMINGTON
State IN
ZIP 47401
Phone 812 824-5205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Pharmacy
Lab Director LAURA JONES

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