25D1021487 CLIA NUMBER - KROGER PHARMACY #454

Laboratory Demographics

CLIA Number: 25D1021487

Facility Name: KROGER PHARMACY #454

Facility Address:
104 HWY 72 WEST
CORINTH, MS
ZIP 38834
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Facility Phone Number: 662 287-8304

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750315537

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	25D1021487
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #454
Street	104 HWY 72 WEST
City	CORINTH
State	MS
ZIP	38834
Phone	662 287-8304
CertificateType	4
CertificateEffectiveDate	1/23/2024
CertificateExpirationDate	1/22/2026
FacilityType	Waiver

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