45D1057181 CLIA NUMBER - KROGER PHARMACY 563

Laboratory Demographics

  • CLIA Code: 45D1057181
  • Facility Name: KROGER PHARMACY 563
  • Facility Address: 4017 14TH STREET
    PLANO, TX
    ZIP 75074
  • Facility Phone: 972 424-7529
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COURTNEY TRAN
  • NPI Number: 1205909736
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1057181
LAB Type Pharmacy
Facility Name KROGER PHARMACY 563
Street 4017 14TH STREET
City PLANO
State TX
ZIP 75074
Phone 972 424-7529
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 COURTNEY TRAN

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