44D1076143 CLIA NUMBER - KROGER PHARMACY 25-398

Laboratory Demographics

  • CLIA Code: 44D1076143
  • Facility Name: KROGER PHARMACY 25-398
  • Facility Address: 941 NORTH PARKWAY ATTN PHARMACY
    JACKSON, TN
    ZIP 38305
  • Facility Phone: 731 423-4904
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MARC WATKINS
  • NPI Number: 1669497384
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1076143
LAB Type Pharmacy
Facility Name KROGER PHARMACY 25-398
Street 941 NORTH PARKWAY ATTN PHARMACY
City JACKSON
State TN
ZIP 38305
Phone 731 423-4904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Pharmacy
Lab Director DR. MARC WATKINS

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