15D1077801 CLIA NUMBER - KROGER PHARMACY #973

Laboratory Demographics

  • CLIA Code: 15D1077801
  • Facility Name: KROGER PHARMACY #973
  • Facility Address: 6002 ST JOE CENTER RD
    FORT WAYNE, IN
    ZIP 46835
  • Facility Phone: 260 492-2054
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER HANLEY
  • NPI Number: 1902979420
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077801
LAB Type Pharmacy
Facility Name KROGER PHARMACY #973
Street 6002 ST JOE CENTER RD
City FORT WAYNE
State IN
ZIP 46835
Phone 260 492-2054
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 JENNIFER HANLEY

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