15D2001076 CLIA NUMBER - KROGER PHARMACY #741

Laboratory Demographics

  • CLIA Code: 15D2001076
  • Facility Name: KROGER PHARMACY #741
  • Facility Address: 525 E CLIFTY DR
    MADISON, IN
    ZIP 47250
  • Facility Phone: 812 273-3343
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHELICISIMA ROBERTS
  • NPI Number: 1497789200
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2001076
LAB Type Pharmacy
Facility Name KROGER PHARMACY #741
Street 525 E CLIFTY DR
City MADISON
State IN
ZIP 47250
Phone 812 273-3343
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 PHELICISIMA ROBERTS

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