45D1095401 CLIA NUMBER - KROGER PHARMACY 689

Laboratory Demographics

  • CLIA Code: 45D1095401
  • Facility Name: KROGER PHARMACY 689
  • Facility Address: 17194 PRESTON ROAD
    DALLAS, TX
    ZIP 75248
  • Facility Phone: 972 931-9371
  • Facility Type: Industrial
  • Facility Type: Waiver
  • Lab Director: SYBIL JACOB
  • NPI Number: 1659444180
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D1095401
LAB Type Industrial
Facility Name KROGER PHARMACY 689
Street 17194 PRESTON ROAD
City DALLAS
State TX
ZIP 75248
Phone 972 931-9371
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Industrial
Lab Director SYBIL JACOB

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