18D2000582 CLIA NUMBER - KROGER PHARMACY 763

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Laboratory Demographics

CLIA Number: 18D2000582

Facility Name: KROGER PHARMACY 763

Facility Address:
520 NORTH 35TH STREET
LOUISVILLE, KY
ZIP 40212
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Facility Phone Number: 502 776-3765

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1568496321

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	18D2000582
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY 763
Street	520 NORTH 35TH STREET
City	LOUISVILLE
State	KY
ZIP	40212
Phone	502 776-3765
CertificateType	4
CertificateEffectiveDate	12/3/2023
CertificateExpirationDate	12/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024