18D2000587 CLIA NUMBER - KROGER PHARMACY 739

Laboratory Demographics

  • CLIA Code: 18D2000587
  • Facility Name: KROGER PHARMACY 739
  • Facility Address: 12450 LAGRANGE ROAD
    LOUISVILLE, KY
    ZIP 40245
  • Facility Phone: 502 241-6770
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1053345819
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2000587
LAB Type Pharmacy
Facility Name KROGER PHARMACY 739
Street 12450 LAGRANGE ROAD
City LOUISVILLE
State KY
ZIP 40245
Phone 502 241-6770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Pharmacy
Lab Director MS. PHELIRISIMA ROBERTS

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