18D2003872 CLIA NUMBER - KROGER PHARMACY L-753

Laboratory Demographics

  • CLIA Code: 18D2003872
  • Facility Name: KROGER PHARMACY L-753
  • Facility Address: 1265 GOSS AVENUE
    LOUISVILLE, KY
    ZIP 40217
  • Facility Phone: 502 634-0649
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PHELICISIMA W. ROBERTS
  • NPI Number: 1659305415
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2003872
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-753
Street 1265 GOSS AVENUE
City LOUISVILLE
State KY
ZIP 40217
Phone 502 634-0649
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2024
Certificate Expiration Date 2/18/2026
Facility Type Pharmacy
Lab Director MS. PHELICISIMA W. ROBERTS

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