45D2000772 CLIA NUMBER - KROGER PHARMACY 990

Laboratory Demographics

  • CLIA Code: 45D2000772
  • Facility Name: KROGER PHARMACY 990
  • Facility Address: 1215 N STREET
    NACOGDOCHES, TX
    ZIP 75961
  • Facility Phone: 936 569-9884
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF LOESCH
  • NPI Number: 1447323977
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2000772
LAB Type Pharmacy
Facility Name KROGER PHARMACY 990
Street 1215 N STREET
City NACOGDOCHES
State TX
ZIP 75961
Phone 936 569-9884
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/4/2023
Certificate Expiration Date 12/3/2025
Facility Type Pharmacy
Lab Director JEFF LOESCH

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