36D2113898 CLIA NUMBER - KROGER PHARMACY #617

Laboratory Demographics

  • CLIA Code: 36D2113898
  • Facility Name: KROGER PHARMACY #617
  • Facility Address: 4633 SUDER AVE
    TOLEDO, OH
    ZIP 43611
  • Facility Phone: 419 727-2650
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEVE BURSON
  • NPI Number: 1710911433
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2113898
LAB Type Pharmacy
Facility Name KROGER PHARMACY #617
Street 4633 SUDER AVE
City TOLEDO
State OH
ZIP 43611
Phone 419 727-2650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2024
Certificate Expiration Date 6/1/2026
Facility Type Pharmacy
Lab Director STEVE BURSON

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