23D2077083 CLIA NUMBER - KROGER CO OF MICHIGAN, THE

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Laboratory Demographics

CLIA Number: 23D2077083

Facility Name: KROGER CO OF MICHIGAN, THE

Facility Address:
3833 N DIXIE HIGHWAY KROGER PHARMACY 018-579 ATTN PHARMACIST IN CHARGE
MONROE, MI
ZIP 48162
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Facility Phone Number: 734 289-6310

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1659305423

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	23D2077083
LAB Type	Other - RETAIL PHARMACY
Facility Name	KROGER CO OF MICHIGAN, THE
Street	3833 N DIXIE HIGHWAY KROGER PHARMACY 018-579 ATTN PHARMACIST IN CHARGE
City	MONROE
State	MI
ZIP	48162
Phone	734 289-6310
CertificateType	4
CertificateEffectiveDate	4/30/2024
CertificateExpirationDate	4/29/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024