36D1013349 CLIA NUMBER - KROGER PHARMACY 014-817

Laboratory Demographics

  • CLIA Code: 36D1013349
  • Facility Name: KROGER PHARMACY 014-817
  • Facility Address: 1230 ROMBACH AVE
    WILMINGTON, OH
    ZIP 45177
  • Facility Phone: 937 655-5720
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1922032622
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1013349
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-817
Street 1230 ROMBACH AVE
City WILMINGTON
State OH
ZIP 45177
Phone 937 655-5720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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