15D2014133 CLIA NUMBER - KROGER PHARMACY #804

Laboratory Demographics

  • CLIA Code: 15D2014133
  • Facility Name: KROGER PHARMACY #804
  • Facility Address: 5810 E 71ST ST
    INDIANAPOLIS, IN
    ZIP 46220
  • Facility Phone: 317 813-1903
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SANDRA DALY
  • NPI Number: 1871739771
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2014133
LAB Type Pharmacy
Facility Name KROGER PHARMACY #804
Street 5810 E 71ST ST
City INDIANAPOLIS
State IN
ZIP 46220
Phone 317 813-1903
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Pharmacy
Lab Director SANDRA DALY

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