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36D1089935 CLIA NUMBER - KROGER PHARMACY #16591

Laboratory Demographics

CLIA Number: 36D1089935

Facility Name: KROGER PHARMACY #16591

Facility Address:
350 EAST BROAD STREET
PATASKALA, OH
ZIP 43062
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Facility Phone Number: 740 964-5105

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1861426579

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 36D1089935
LAB Type Pharmacy
Facility Name KROGER PHARMACY #16591
Street 350 EAST BROAD STREET
City PATASKALA
State OH
ZIP 43062
Phone 740 964-5105
CertificateType 4
CertificateEffectiveDate 9/30/2022
CertificateExpirationDate 9/29/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024