36D1019809 CLIA NUMBER - KROGER PHARMACY 014-829

Laboratory Demographics

  • CLIA Code: 36D1019809
  • Facility Name: KROGER PHARMACY 014-829
  • Facility Address: 1700 WEST PARK SQUARE
    XENIA, OH
    ZIP 45385
  • Facility Phone: 937 754-4427
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1467486167
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1019809
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-829
Street 1700 WEST PARK SQUARE
City XENIA
State OH
ZIP 45385
Phone 937 754-4427
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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