45D1082381 CLIA NUMBER - KROGER PHARMACY 590

Laboratory Demographics

  • CLIA Code: 45D1082381
  • Facility Name: KROGER PHARMACY 590
  • Facility Address: 1004 S CROWLER ROAD
    CROWLEY, TX
    ZIP 76036
  • Facility Phone: 817 297-0006
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: MATT JOHANSEN
  • NPI Number: 1033282561
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1082381
LAB Type Industrial
Facility Name KROGER PHARMACY 590
Street 1004 S CROWLER ROAD
City CROWLEY
State TX
ZIP 76036
Phone 817 297-0006
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2024
Certificate Expiration Date 4/7/2026
Facility Type Industrial
Lab Director MATT JOHANSEN

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