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44D1059929 CLIA NUMBER - KROGER PHARMACY 25-433

Laboratory Demographics

CLIA Number: 44D1059929

Facility Name: KROGER PHARMACY 25-433

Facility Address:
11630 HWY 51 S ATTN PHARMACY
ATOKA, TN
ZIP 38004
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Facility Phone Number: 901 837-5010

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1639273733

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 44D1059929
LAB Type Pharmacy
Facility Name KROGER PHARMACY 25-433
Street 11630 HWY 51 S ATTN PHARMACY
City ATOKA
State TN
ZIP 38004
Phone 901 837-5010
CertificateType 4
CertificateEffectiveDate 10/11/2022
CertificateExpirationDate 10/10/2024
FacilityType Waiver

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