18D2000238 CLIA NUMBER - KROGER PHARMACY L-563

Laboratory Demographics

  • CLIA Code: 18D2000238
  • Facility Name: KROGER PHARMACY L-563
  • Facility Address: 545 ISLAND FORD RD
    MADISONVILLE, KY
    ZIP 42431
  • Facility Phone: 270 821-0692
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1700810520
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2000238
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-563
Street 545 ISLAND FORD RD
City MADISONVILLE
State KY
ZIP 42431
Phone 270 821-0692
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/24/2023
Certificate Expiration Date 11/23/2025
Facility Type Pharmacy
Lab Director MS. PHELIRISIMA ROBERTS

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