36D2112409 CLIA NUMBER - KROGER PHARMACY

Laboratory Demographics

  • CLIA Code: 36D2112409
  • Facility Name: KROGER PHARMACY
  • Facility Address: 790 W MARKET ST
    TIFFIN, OH
    ZIP 44883
  • Facility Phone: 419 447-8304
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEVE BURSON
  • NPI Number: 1760416481
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2112409
LAB Type Pharmacy
Facility Name KROGER PHARMACY
Street 790 W MARKET ST
City TIFFIN
State OH
ZIP 44883
Phone 419 447-8304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Pharmacy
Lab Director STEVE BURSON

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