45D1095010 CLIA NUMBER - KROGER PHARMACY 950

Laboratory Demographics

  • CLIA Code: 45D1095010
  • Facility Name: KROGER PHARMACY 950
  • Facility Address: 1600 N 16TH ST
    ORANGE, TX
    ZIP 77630
  • Facility Phone: 409 886-1362
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLEE VIDRINE
  • NPI Number: 1326111840
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1095010
LAB Type Pharmacy
Facility Name KROGER PHARMACY 950
Street 1600 N 16TH ST
City ORANGE
State TX
ZIP 77630
Phone 409 886-1362
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 KYLEE VIDRINE

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