36D2053104 CLIA NUMBER - KROGER PHARMACY 014-722

Laboratory Demographics

  • CLIA Code: 36D2053104
  • Facility Name: KROGER PHARMACY 014-722
  • Facility Address: 10101 LANDING WAY ATTN PHARMACIST IN CHARGE
    MIAMISBURG, OH
    ZIP 45342
  • Facility Phone: 937 384-4220
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE IZOR
  • NPI Number: 1043368046
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2053104
LAB Type Pharmacy
Facility Name KROGER PHARMACY 014-722
Street 10101 LANDING WAY ATTN PHARMACIST IN CHARGE
City MIAMISBURG
State OH
ZIP 45342
Phone 937 384-4220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2025
Certificate Expiration Date 1/24/2027
Facility Type Pharmacy
Lab Director MICHELLE IZOR

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