45D1067624 CLIA NUMBER - KROGER PHARMACY 584

Laboratory Demographics

  • CLIA Code: 45D1067624
  • Facility Name: KROGER PHARMACY 584
  • Facility Address: 3001 MATLOCK
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 473-0081
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTIE JONES
  • NPI Number: 1740353358
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1067624
LAB Type Pharmacy
Facility Name KROGER PHARMACY 584
Street 3001 MATLOCK
City MANSFIELD
State TX
ZIP 76063
Phone 817 473-0081
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director KRISTIE JONES

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