44D1009234 CLIA NUMBER - KROGER PHARMACY STORE #392

Laboratory Demographics

  • CLIA Code: 44D1009234
  • Facility Name: KROGER PHARMACY STORE #392
  • Facility Address: 2525 NICHOLS AVENUE ATTN PHARMACY
    DYERSBURG, TN
    ZIP 38024
  • Facility Phone: 731 285-6030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MARC WATKINS
  • NPI Number: 1215961941
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1009234
LAB Type Pharmacy
Facility Name KROGER PHARMACY STORE #392
Street 2525 NICHOLS AVENUE ATTN PHARMACY
City DYERSBURG
State TN
ZIP 38024
Phone 731 285-6030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type Pharmacy
Lab Director DR. MARC WATKINS

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