15D1078654 CLIA NUMBER - KROGER PHARMACY 909

Laboratory Demographics

  • CLIA Code: 15D1078654
  • Facility Name: KROGER PHARMACY 909
  • Facility Address: 3100 MERIDIAN PARK DR
    GREENWOOD, IN
    ZIP 46142
  • Facility Phone: 317 887-5757
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEVE SIDHOM
  • NPI Number: 1578636197
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1078654
LAB Type Pharmacy
Facility Name KROGER PHARMACY 909
Street 3100 MERIDIAN PARK DR
City GREENWOOD
State IN
ZIP 46142
Phone 317 887-5757
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2024
Certificate Expiration Date 1/13/2026
Facility Type Pharmacy
Lab Director STEVE SIDHOM

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