45D1095004 CLIA NUMBER - KROGER PHARMACY 490

Laboratory Demographics

  • CLIA Code: 45D1095004
  • Facility Name: KROGER PHARMACY 490
  • Facility Address: 2415 HWY 79 SOUTH
    HENDERSON, TX
    ZIP 75652
  • Facility Phone: 903 657-8596
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF LOESCH
  • NPI Number: 1497828792
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1095004
LAB Type Pharmacy
Facility Name KROGER PHARMACY 490
Street 2415 HWY 79 SOUTH
City HENDERSON
State TX
ZIP 75652
Phone 903 657-8596
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Pharmacy
Lab Director JEFF LOESCH

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