44D1093962 CLIA NUMBER - KROGER PHARMACY L-578

Laboratory Demographics

  • CLIA Code: 44D1093962
  • Facility Name: KROGER PHARMACY L-578
  • Facility Address: 401 S MT JULIET ROAD SUITE 200 ATTN PHARMACY
    MOUNT JULIET, TN
    ZIP 37122
  • Facility Phone: 615 758-3322
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MARC WATKINS
  • NPI Number: 1336173061
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1093962
LAB Type Pharmacy
Facility Name KROGER PHARMACY L-578
Street 401 S MT JULIET ROAD SUITE 200 ATTN PHARMACY
City MOUNT JULIET
State TN
ZIP 37122
Phone 615 758-3322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2025
Certificate Expiration Date 1/6/2027
Facility Type Pharmacy
Lab Director DR. MARC WATKINS

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