45D1058730 CLIA NUMBER - KROGER PHARMACY 383

Laboratory Demographics

  • CLIA Code: 45D1058730
  • Facility Name: KROGER PHARMACY 383
  • Facility Address: 2303 BOONEVILLE RD
    BRYAN, TX
    ZIP 77808
  • Facility Phone: 979 774-8377
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEBORAH L. VESELKA
  • NPI Number: 1821161357
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1058730
LAB Type Pharmacy
Facility Name KROGER PHARMACY 383
Street 2303 BOONEVILLE RD
City BRYAN
State TX
ZIP 77808
Phone 979 774-8377
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Pharmacy
Lab Director DEBORAH L. VESELKA

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