25D1078532 CLIA NUMBER - KROGER PHARMACY #472

Laboratory Demographics

  • CLIA Code: 25D1078532
  • Facility Name: KROGER PHARMACY #472
  • Facility Address: 115 COLONY CROSSING WAY
    MADISON, MS
    ZIP 39110
  • Facility Phone: 601 605-5024
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1245415868
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1078532
LAB Type Pharmacy
Facility Name KROGER PHARMACY #472
Street 115 COLONY CROSSING WAY
City MADISON
State MS
ZIP 39110
Phone 601 605-5024
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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