36D1050359 CLIA NUMBER - KROGER PHARMACY 014-747

Laboratory Demographics

  • CLIA Code: 36D1050359
  • Facility Name: KROGER PHARMACY 014-747
  • Facility Address: 780 NORTHWOODS BLVD
    VANDALIA, OH
    ZIP 45377
  • Facility Phone: 937 264-2420
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1659305357
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1050359
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-747
Street 780 NORTHWOODS BLVD
City VANDALIA
State OH
ZIP 45377
Phone 937 264-2420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/1/2024
Certificate Expiration Date 1/31/2026
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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