25D1090849 CLIA NUMBER - KROGER PHARMACY #466

Laboratory Demographics

  • CLIA Code: 25D1090849
  • Facility Name: KROGER PHARMACY #466
  • Facility Address: 3408 PEMBERTON SQUARE BLVD
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 638-3251
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1164670063
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1090849
LAB Type Industrial
Facility Name KROGER PHARMACY #466
Street 3408 PEMBERTON SQUARE BLVD
City VICKSBURG
State MS
ZIP 39180
Phone 601 638-3251
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