15D1078658 CLIA NUMBER - KROGER PHARMACY 960

Laboratory Demographics

  • CLIA Code: 15D1078658
  • Facility Name: KROGER PHARMACY 960
  • Facility Address: 500 S LIBERTY DRIVE
    BLOOMINGTON, IN
    ZIP 47403
  • Facility Phone: 812 349-1392
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAUREN MCCAULEY
  • NPI Number: 1750454062
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1078658
LAB Type Pharmacy
Facility Name KROGER PHARMACY 960
Street 500 S LIBERTY DRIVE
City BLOOMINGTON
State IN
ZIP 47403
Phone 812 349-1392
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 LAUREN MCCAULEY

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