25D1021482 CLIA NUMBER - KROGER PHARMACY #388

Laboratory Demographics

  • CLIA Code: 25D1021482
  • Facility Name: KROGER PHARMACY #388
  • Facility Address: 1811 WEST GOVERNMENT STREET
    BRANDON, MS
    ZIP 39042
  • Facility Phone: 601 825-3697
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1184658957
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1021482
LAB Type Pharmacy
Facility Name KROGER PHARMACY #388
Street 1811 WEST GOVERNMENT STREET
City BRANDON
State MS
ZIP 39042
Phone 601 825-3697
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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This page was last updated on: 6/4/2025