25D1038556 CLIA NUMBER - KROGER PHARMACY #490

Laboratory Demographics

  • CLIA Code: 25D1038556
  • Facility Name: KROGER PHARMACY #490
  • Facility Address: 6745 SIWELL ROAD
    BYRAM, MS
    ZIP 39272
  • Facility Phone: 601 863-2006
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1467486241
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1038556
LAB Type Pharmacy
Facility Name KROGER PHARMACY #490
Street 6745 SIWELL ROAD
City BYRAM
State MS
ZIP 39272
Phone 601 863-2006
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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