42D1005269 CLIA NUMBER - KROGER PHARMACY #16

Laboratory Demographics

  • CLIA Code: 42D1005269
  • Facility Name: KROGER PHARMACY #16
  • Facility Address: 9600 NORTH KINGS HIGHWAY
    MYRTLE BEACH, SC
    ZIP 29577
  • Facility Phone: 843 449-2158
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA A. CHAPMAN
  • NPI Number: 1780618405
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D1005269
LAB Type Pharmacy
Facility Name KROGER PHARMACY #16
Street 9600 NORTH KINGS HIGHWAY
City MYRTLE BEACH
State SC
ZIP 29577
Phone 843 449-2158
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type Pharmacy
Lab Director LISA A. CHAPMAN

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