25D2004492 CLIA NUMBER - KROGER PHARMACY #494

Laboratory Demographics

  • CLIA Code: 25D2004492
  • Facility Name: KROGER PHARMACY #494
  • Facility Address: 7045 OLD CANTON ROAD
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 601 856-0977
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1417279738
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2004492
LAB Type Pharmacy
Facility Name KROGER PHARMACY #494
Street 7045 OLD CANTON ROAD
City RIDGELAND
State MS
ZIP 39157
Phone 601 856-0977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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