19D2016592 CLIA NUMBER - KROGER PHARMACY # 35-534

Laboratory Demographics

  • CLIA Code: 19D2016592
  • Facility Name: KROGER PHARMACY # 35-534
  • Facility Address: 1050 GEORGE DEMENT BLVD
    BOSSIER CITY, LA
    ZIP 71111
  • Facility Phone: 318 747-3162
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRIS BLAYLOCK
  • NPI Number: 1073686598
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2016592
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 35-534
Street 1050 GEORGE DEMENT BLVD
City BOSSIER CITY
State LA
ZIP 71111
Phone 318 747-3162
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Pharmacy
Lab Director KRIS BLAYLOCK

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