23D2077075 CLIA NUMBER - KROGER CO OF MICHIGAN #018-749, THE

Laboratory Demographics

  • CLIA Code: 23D2077075
  • Facility Name: KROGER CO OF MICHIGAN #018-749, THE
  • Facility Address: 22801 HARPER AVE
    SAINT CLAIR SHORES, MI
    ZIP 48080
  • Facility Phone: 586 800-5190
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: BAN GEORGE
  • NPI Number: 1154521060
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2077075
LAB Type Other - PHARMACY
Facility Name KROGER CO OF MICHIGAN #018-749, THE
Street 22801 HARPER AVE
City SAINT CLAIR SHORES
State MI
ZIP 48080
Phone 586 800-5190
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Other - PHARMACY
Lab Director BAN GEORGE

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This page was last updated on: 3/20/2025