45D1067430 CLIA NUMBER - KROGER PHARMACY 256

Laboratory Demographics

  • CLIA Code: 45D1067430
  • Facility Name: KROGER PHARMACY 256
  • Facility Address: 1804 N VELASCO
    ANGLETON, TX
    ZIP 77515
  • Facility Phone: 979 849-5460
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MINI MARKOSE
  • NPI Number: 1912070533
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1067430
LAB Type Pharmacy
Facility Name KROGER PHARMACY 256
Street 1804 N VELASCO
City ANGLETON
State TX
ZIP 77515
Phone 979 849-5460
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2025
Certificate Expiration Date 4/17/2027
Facility Type Pharmacy
Lab Director MINI MARKOSE

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