42D1005274 CLIA NUMBER - KROGER PHARMACY #020

Laboratory Demographics

  • CLIA Code: 42D1005274
  • Facility Name: KROGER PHARMACY #020
  • Facility Address: 781 MAIN STREET
    NORTH MYRTLE BEACH, SC
    ZIP 29582
  • Facility Phone: 843 249-9967
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: LIZA CHAPMAN
  • NPI Number: 1417981143
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D1005274
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #020
Street 781 MAIN STREET
City NORTH MYRTLE BEACH
State SC
ZIP 29582
Phone 843 249-9967
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Other - RETAIL PHARMACY
Lab Director LIZA CHAPMAN

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