36D2028731 CLIA NUMBER - KROGER PHARMACY #014838

Laboratory Demographics

  • CLIA Code: 36D2028731
  • Facility Name: KROGER PHARMACY #014838
  • Facility Address: 1161 E DAYTON-YELLOW SPRINGS ROAD
    FAIRBORN, OH
    ZIP 45324
  • Facility Phone: 937 318-3920
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1740403401
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 36D2028731
LAB Type Pharmacy
Facility Name KROGER PHARMACY #014838
Street 1161 E DAYTON-YELLOW SPRINGS ROAD
City FAIRBORN
State OH
ZIP 45324
Phone 937 318-3920
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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