25D1090846 CLIA NUMBER - KROGER PHARMACY #474

Laboratory Demographics

  • CLIA Code: 25D1090846
  • Facility Name: KROGER PHARMACY #474
  • Facility Address: 107 HWY 80 EAST
    CLINTON, MS
    ZIP 39056
  • Facility Phone: 601 926-1955
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1376791962
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1090846
LAB Type Industrial
Facility Name KROGER PHARMACY #474
Street 107 HWY 80 EAST
City CLINTON
State MS
ZIP 39056
Phone 601 926-1955
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2024
Certificate Expiration Date 10/19/2026
Facility Type Industrial
Lab Director CYNTHIA B. FISHER

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