25D2004492 CLIA NUMBER - KROGER PHARMACY #494

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Laboratory Demographics

CLIA Number: 25D2004492

Facility Name: KROGER PHARMACY #494

Facility Address:
7045 OLD CANTON ROAD
RIDGELAND, MS
ZIP 39157
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Facility Phone Number: 601 856-0977

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1417279738

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	3/5/2024
CertificateExpirationDate	3/4/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024