25D2029470 CLIA NUMBER - KROGER PHARMACY #499

Laboratory Demographics

  • CLIA Code: 25D2029470
  • Facility Name: KROGER PHARMACY #499
  • Facility Address: 3926 GOODMAN ROAD
    HORN LAKE, MS
    ZIP 38637
  • Facility Phone: 901 754-5124
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1194005629
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2029470
LAB Type Pharmacy
Facility Name KROGER PHARMACY #499
Street 3926 GOODMAN ROAD
City HORN LAKE
State MS
ZIP 38637
Phone 901 754-5124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2025
Certificate Expiration Date 9/7/2027
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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