25D1088801 CLIA NUMBER - KROGER PHARMACY #493

Laboratory Demographics

  • CLIA Code: 25D1088801
  • Facility Name: KROGER PHARMACY #493
  • Facility Address: 1070 SPILLWAY CIRCLE
    BRANDON, MS
    ZIP 39047
  • Facility Phone: 901 765-4330
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1538317532
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D1088801
LAB Type Pharmacy
Facility Name KROGER PHARMACY #493
Street 1070 SPILLWAY CIRCLE
City BRANDON
State MS
ZIP 39047
Phone 901 765-4330
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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