45D2001215 CLIA NUMBER - KROGER PHARMACY 319

Laboratory Demographics

  • CLIA Code: 45D2001215
  • Facility Name: KROGER PHARMACY 319
  • Facility Address: 1300 FAIRMONT PARKWAY
    LA PORTE, TX
    ZIP 77571
  • Facility Phone: 281 842-1022
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ULLYSIS ANAYA
  • NPI Number: 1154494771
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001215
LAB Type Pharmacy
Facility Name KROGER PHARMACY 319
Street 1300 FAIRMONT PARKWAY
City LA PORTE
State TX
ZIP 77571
Phone 281 842-1022
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2023
Certificate Expiration Date 12/14/2025
Facility Type Pharmacy
Lab Director ULLYSIS ANAYA

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