45D1057175 CLIA NUMBER - KROGER PHARMACY 512

Laboratory Demographics

  • CLIA Code: 45D1057175
  • Facility Name: KROGER PHARMACY 512
  • Facility Address: 2110 E SOUTHLAKE BLVD
    SOUTHLAKE, TX
    ZIP 76092
  • Facility Phone: 817 421-7487
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAUREN L. NGUYEN
  • NPI Number: 1336212950
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1057175
LAB Type Pharmacy
Facility Name KROGER PHARMACY 512
Street 2110 E SOUTHLAKE BLVD
City SOUTHLAKE
State TX
ZIP 76092
Phone 817 421-7487
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Pharmacy
Lab Director LAUREN L. NGUYEN

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