18D2025861 CLIA NUMBER - KROGER PHARMACY #420

Laboratory Demographics

  • CLIA Code: 18D2025861
  • Facility Name: KROGER PHARMACY #420
  • Facility Address: 381 MARKET SQUARE DRIVE
    MAYSVILLE, KY
    ZIP 41056
  • Facility Phone: 606 759-7973
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: MS. MICHELLE IZOR
  • NPI Number: 1710911532
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2025861
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #420
Street 381 MARKET SQUARE DRIVE
City MAYSVILLE
State KY
ZIP 41056
Phone 606 759-7973
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 - RETAIL PHARMACY
Lab Director MS. MICHELLE IZOR

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