15D2001071 CLIA NUMBER - KROGER PHARMACY #762

Laboratory Demographics

  • CLIA Code: 15D2001071
  • Facility Name: KROGER PHARMACY #762
  • Facility Address: 305 E LEWIS AND CLARK PKWY
    CLARKSVILLE, IN
    ZIP 47129
  • Facility Phone: 812 948-8065
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELIRISIMA ROBERTS
  • NPI Number: 1952335762
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2001071
LAB Type Pharmacy
Facility Name KROGER PHARMACY #762
Street 305 E LEWIS AND CLARK PKWY
City CLARKSVILLE
State IN
ZIP 47129
Phone 812 948-8065
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2023
Certificate Expiration Date 12/10/2025
Facility Type Pharmacy
Lab Director PHELIRISIMA ROBERTS

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