18D1032500 CLIA NUMBER - KROGER PHARMACY L903

Laboratory Demographics

  • CLIA Code: 18D1032500
  • Facility Name: KROGER PHARMACY L903
  • Facility Address: 568 RIVER RIDGE PLAZA
    BRANDENBURG, KY
    ZIP 40108
  • Facility Phone: 270 422-3532
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1619901451
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D1032500
LAB Type Pharmacy
Facility Name KROGER PHARMACY L903
Street 568 RIVER RIDGE PLAZA
City BRANDENBURG
State KY
ZIP 40108
Phone 270 422-3532
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Pharmacy
Lab Director MS. PHELIRISIMA ROBERTS

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This page was last updated on: 3/20/2025