15D2140597 CLIA NUMBER - KROGER PHARMACY #989

Laboratory Demographics

  • CLIA Code: 15D2140597
  • Facility Name: KROGER PHARMACY #989
  • Facility Address: 8130 E SOUTHPORT RD
    INDIANAPOLIS, IN
    ZIP 46259
  • Facility Phone: 317 245-4454
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL BUSUTTIL
  • NPI Number: 1316472376
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2140597
LAB Type Pharmacy
Facility Name KROGER PHARMACY #989
Street 8130 E SOUTHPORT RD
City INDIANAPOLIS
State IN
ZIP 46259
Phone 317 245-4454
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Pharmacy
Lab Director MICHAEL BUSUTTIL

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