45D1057200 CLIA NUMBER - KROGER PHARMACY 540

Laboratory Demographics

  • CLIA Code: 45D1057200
  • Facility Name: KROGER PHARMACY 540
  • Facility Address: 3305 N DALLAS PKWY
    PLANO, TX
    ZIP 75093
  • Facility Phone: 972 608-4694
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW WILLNER
  • NPI Number: 1982777298
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1057200
LAB Type Pharmacy
Facility Name KROGER PHARMACY 540
Street 3305 N DALLAS PKWY
City PLANO
State TX
ZIP 75093
Phone 972 608-4694
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 ANDREW WILLNER

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