36D2030247 CLIA NUMBER - KROGER PHARMACY 014-920

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Laboratory Demographics

CLIA Number: 36D2030247

Facility Name: KROGER PHARMACY 014-920

Facility Address:
210 STERLING RUN BLVD
MOUNT ORAB, OH
ZIP 45154
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Facility Phone Number: 937 444-5014

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1043244759

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	36D2030247
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY 014-920
Street	210 STERLING RUN BLVD
City	MOUNT ORAB
State	OH
ZIP	45154
Phone	937 444-5014
CertificateType	4
CertificateEffectiveDate	9/23/2023
CertificateExpirationDate	9/22/2025
FacilityType	Waiver

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