18D2025859 CLIA NUMBER - KROGER PHARMACY 014-475

Laboratory Demographics

  • CLIA Code: 18D2025859
  • Facility Name: KROGER PHARMACY 014-475
  • Facility Address: 1700 DECLARATION DRIVE
    INDEPENDENCE, KY
    ZIP 41051
  • Facility Phone: 859 898-1620
  • Facility Type: Other - REATIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: MS. MICHELLE IZOR
  • NPI Number: 1700810546
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2025859
LAB Type Other - REATIL PHARMACY
Facility Name KROGER PHARMACY 014-475
Street 1700 DECLARATION DRIVE
City INDEPENDENCE
State KY
ZIP 41051
Phone 859 898-1620
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Other - REATIL PHARMACY
Lab Director MS. MICHELLE IZOR

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