15D1077921 CLIA NUMBER - KROGER PHARMACY 248

Laboratory Demographics

  • CLIA Code: 15D1077921
  • Facility Name: KROGER PHARMACY 248
  • Facility Address: 100 FOREST PARK PLAZA
    BRAZIL, IN
    ZIP 47834
  • Facility Phone: 812 442-6700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN ERNEST
  • NPI Number: 1912070434
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077921
LAB Type Pharmacy
Facility Name KROGER PHARMACY 248
Street 100 FOREST PARK PLAZA
City BRAZIL
State IN
ZIP 47834
Phone 812 442-6700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Pharmacy
Lab Director STEPHEN ERNEST

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