45D1063911 CLIA NUMBER - KROGER PHARMACY 588

Laboratory Demographics

  • CLIA Code: 45D1063911
  • Facility Name: KROGER PHARMACY 588
  • Facility Address: 9140 FOREST LANE
    DALLAS, TX
    ZIP 75243
  • Facility Phone: 214 221-0978
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JILL LESTER
  • NPI Number: 1952474470
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1063911
LAB Type Pharmacy
Facility Name KROGER PHARMACY 588
Street 9140 FOREST LANE
City DALLAS
State TX
ZIP 75243
Phone 214 221-0978
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 JILL LESTER

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