36D1096851 CLIA NUMBER - KROGER PHARMACY 014-825

Laboratory Demographics

  • CLIA Code: 36D1096851
  • Facility Name: KROGER PHARMACY 014-825
  • Facility Address: 2115 EAST DOROTHY LANE
    KETTERING, OH
    ZIP 45420
  • Facility Phone: 937 299-8437
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1407880107
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D1096851
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-825
Street 2115 EAST DOROTHY LANE
City KETTERING
State OH
ZIP 45420
Phone 937 299-8437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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