15D2089784 CLIA NUMBER - KROGER PHARMACY #014-827

Laboratory Demographics

  • CLIA Code: 15D2089784
  • Facility Name: KROGER PHARMACY #014-827
  • Facility Address: 516 WEST 30TH STREET
    CONNERSVILLE, IN
    ZIP 47331
  • Facility Phone: 765 825-5222
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1306870118
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2089784
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #014-827
Street 516 WEST 30TH STREET
City CONNERSVILLE
State IN
ZIP 47331
Phone 765 825-5222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2025
Certificate Expiration Date 1/7/2027
Facility Type Other - RETAIL PHARMACY
Lab Director MICHELLE IZOR

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