44D1078012 CLIA NUMBER - KROGER PHARMACY L-503

Laboratory Demographics

  • CLIA Code: 44D1078012
  • Facility Name: KROGER PHARMACY L-503
  • Facility Address: 1840 DECHERD BLVD ATTN PHARMACY
    DECHERD, TN
    ZIP 37324
  • Facility Phone: 931 967-1218
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MARC WATKINS
  • NPI Number: 1851325583
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1078012
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-503
Street 1840 DECHERD BLVD ATTN PHARMACY
City DECHERD
State TN
ZIP 37324
Phone 931 967-1218
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/26/2023
Certificate Expiration Date 12/25/2025
Facility Type Pharmacy
Lab Director DR. MARC WATKINS

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