42D1001173 CLIA NUMBER - KROGER PHARMACY

Laboratory Demographics

CLIA Number: 42D1001173

Facility Name: KROGER PHARMACY

Facility Address:
3403 FOREST DRIVE
COLUMBIA, SC
ZIP 29204
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Facility Phone Number: 803 782-4027

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1699709329

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	42D1001173
LAB Type	Other - RETAIL PHARMACY
Facility Name	KROGER PHARMACY
Street	3403 FOREST DRIVE
City	COLUMBIA
State	SC
ZIP	29204
Phone	803 782-4027
CertificateType	4
CertificateEffectiveDate	4/13/2024
CertificateExpirationDate	4/12/2026
FacilityType	Waiver

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