19D2016591 CLIA NUMBER - KROGER PHARMACY # 35-539

Laboratory Demographics

  • CLIA Code: 19D2016591
  • Facility Name: KROGER PHARMACY # 35-539
  • Facility Address: 6652 YOUREE DRIVE
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 795-9966
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN MASON
  • NPI Number: 1598215840
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2016591
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 35-539
Street 6652 YOUREE DRIVE
City SHREVEPORT
State LA
ZIP 71105
Phone 318 795-9966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2024
Certificate Expiration Date 11/18/2026
Facility Type Pharmacy
Lab Director BRIAN MASON

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