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45D1063904 CLIA NUMBER - KROGER PHARMACY 439

Laboratory Demographics

CLIA Number: 45D1063904

Facility Name: KROGER PHARMACY 439

Facility Address:
9114 CAMP BOWIE WEST BLVD
FORT WORTH, TX
ZIP 76116
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Facility Phone Number: 817 560-4233

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1508939828

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 45D1063904
LAB Type Pharmacy
Facility Name KROGER PHARMACY 439
Street 9114 CAMP BOWIE WEST BLVD
City FORT WORTH
State TX
ZIP 76116
Phone 817 560-4233
CertificateType 4
CertificateEffectiveDate 1/24/2023
CertificateExpirationDate 1/23/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024