25D1033959 CLIA NUMBER - KROGER PHARMACY #479

Laboratory Demographics

  • CLIA Code: 25D1033959
  • Facility Name: KROGER PHARMACY #479
  • Facility Address: 110 PROMENADE
    FLOWOOD, MS
    ZIP 39232
  • Facility Phone: 601 718-2233
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1194759977
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1033959
LAB Type Pharmacy
Facility Name KROGER PHARMACY #479
Street 110 PROMENADE
City FLOWOOD
State MS
ZIP 39232
Phone 601 718-2233
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2024
Certificate Expiration Date 11/21/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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