15D1078655 CLIA NUMBER - KROGER PHARMACY 914

Laboratory Demographics

  • CLIA Code: 15D1078655
  • Facility Name: KROGER PHARMACY 914
  • Facility Address: 3701 E NATIONAL RD
    RICHMOND, IN
    ZIP 47374
  • Facility Phone: 765 935-2074
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRAVIS MAINOUS
  • NPI Number: 1124191747
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1078655
LAB Type Pharmacy
Facility Name KROGER PHARMACY 914
Street 3701 E NATIONAL RD
City RICHMOND
State IN
ZIP 47374
Phone 765 935-2074
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 TRAVIS MAINOUS

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