36D2040892 CLIA NUMBER - KROGER PHARMACY #910

Laboratory Demographics

  • CLIA Code: 36D2040892
  • Facility Name: KROGER PHARMACY #910
  • Facility Address: 475 FORTMAN DRIVE
    ST MARYS, OH
    ZIP 45885
  • Facility Phone: 419 394-8930
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1821029919
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2040892
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #910
Street 475 FORTMAN DRIVE
City ST MARYS
State OH
ZIP 45885
Phone 419 394-8930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Other - RETAIL PHARMACY
Lab Director MICHELLE IZOR

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