45D1063909 CLIA NUMBER - KROGER PHARMACY 568

Laboratory Demographics

  • CLIA Code: 45D1063909
  • Facility Name: KROGER PHARMACY 568
  • Facility Address: 1320 W MCDERMOTT DRIVE
    ALLEN, TX
    ZIP 75013
  • Facility Phone: 214 495-0204
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMES T. SAMUEL
  • NPI Number: 1417020934
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1063909
LAB Type Pharmacy
Facility Name KROGER PHARMACY 568
Street 1320 W MCDERMOTT DRIVE
City ALLEN
State TX
ZIP 75013
Phone 214 495-0204
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 JAMES T. SAMUEL

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