36D1036920 CLIA NUMBER - KROGER PHARMACY 014-939

Laboratory Demographics

  • CLIA Code: 36D1036920
  • Facility Name: KROGER PHARMACY 014-939
  • Facility Address: 560 WESSEL DRIVE
    FAIRFIELD, OH
    ZIP 45014
  • Facility Phone: 513 829-2005
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1114951902
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1036920
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-939
Street 560 WESSEL DRIVE
City FAIRFIELD
State OH
ZIP 45014
Phone 513 829-2005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2025
Certificate Expiration Date 2/10/2027
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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