18D2000594 CLIA NUMBER - KROGER PHARMACY 717

Laboratory Demographics

  • CLIA Code: 18D2000594
  • Facility Name: KROGER PHARMACY 717
  • Facility Address: 3040 DOLPHIN DRIVE
    ELIZABETHTOWN, KY
    ZIP 42701
  • Facility Phone: (502) 737-4578
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELIRISIMA ROBERTS
  • NPI Number: 1881619567
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2000594
LAB Type Pharmacy
Facility Name KROGER PHARMACY 717
Street 3040 DOLPHIN DRIVE
City ELIZABETHTOWN
State KY
ZIP 42701
Phone 5027374578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2025
Certificate Expiration Date 12/2/2027
Facility Type Pharmacy
Lab Director MS. PHELIRISIMA ROBERTS

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This page was last updated on: 5/18/2026