45D2000953 CLIA NUMBER - KROGER PHARMACY #014

Laboratory Demographics

  • CLIA Code: 45D2000953
  • Facility Name: KROGER PHARMACY #014
  • Facility Address: 12605 I-45 N
    WILLIS, TX
    ZIP 77318
  • Facility Phone: 936 890-3949
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TINA CHERIAN
  • NPI Number: 1952474264
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2000953
LAB Type Pharmacy
Facility Name KROGER PHARMACY #014
Street 12605 I-45 N
City WILLIS
State TX
ZIP 77318
Phone 936 890-3949
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Pharmacy
Lab Director TINA CHERIAN

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