36D1030694 CLIA NUMBER - KROGER PHARMACY 014-811

Laboratory Demographics

  • CLIA Code: 36D1030694
  • Facility Name: KROGER PHARMACY 014-811
  • Facility Address: 3165 DAYTON XENIA ROAD STE 5
    BEAVERCREEK, OH
    ZIP 45434
  • Facility Phone: 937 431-8230
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1013941723
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 36D1030694
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-811
Street 3165 DAYTON XENIA ROAD STE 5
City BEAVERCREEK
State OH
ZIP 45434
Phone 937 431-8230
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Pharmacy
Lab Director MICHELLE IZOR

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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