15D2093624 CLIA NUMBER - KROGER PHARMACY #427

Laboratory Demographics

  • CLIA Code: 15D2093624
  • Facility Name: KROGER PHARMACY #427
  • Facility Address: 2040 PEACE TREE VLG
    ROCHESTER, IN
    ZIP 46975
  • Facility Phone: 574 223-6347
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANSAM SAWALHA
  • NPI Number: 1447323969
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2093624
LAB Type Pharmacy
Facility Name KROGER PHARMACY #427
Street 2040 PEACE TREE VLG
City ROCHESTER
State IN
ZIP 46975
Phone 574 223-6347
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director ANSAM SAWALHA

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