45D1063904 CLIA NUMBER - KROGER PHARMACY 439

Laboratory Demographics

  • CLIA Code: 45D1063904
  • Facility Name: KROGER PHARMACY 439
  • Facility Address: 9114 CAMP BOWIE WEST BLVD
    FORT WORTH, TX
    ZIP 76116
  • Facility Phone: 817 560-4233
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WES SKALAK
  • NPI Number: 1508939828
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Pharmacy
Lab Director WES SKALAK

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