18D2000242 CLIA NUMBER - KROGER PHARMACY L-411

Laboratory Demographics

  • CLIA Code: 18D2000242
  • Facility Name: KROGER PHARMACY L-411
  • Facility Address: 179 WEST COLLEGE AVE
    STANTON, KY
    ZIP 40380
  • Facility Phone: 606 663-2663
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1780618546
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2000242
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-411
Street 179 WEST COLLEGE AVE
City STANTON
State KY
ZIP 40380
Phone 606 663-2663
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: 9/29/2025