18D1107692 CLIA NUMBER - KROGER PHARMACY L-336

Laboratory Demographics

  • CLIA Code: 18D1107692
  • Facility Name: KROGER PHARMACY L-336
  • Facility Address: 2308 EAST 4TH STREET
    OWENSBORO, KY
    ZIP 42303
  • Facility Phone: 270 926-7751
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1083648828
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D1107692
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-336
Street 2308 EAST 4TH STREET
City OWENSBORO
State KY
ZIP 42303
Phone 270 926-7751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Pharmacy
Lab Director MS. PHELIRISIMA ROBERTS

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