45D2001551 CLIA NUMBER - KROGER PHARMACY 209

Laboratory Demographics

  • CLIA Code: 45D2001551
  • Facility Name: KROGER PHARMACY 209
  • Facility Address: 525 N GALLOWAY
    MESQUITE, TX
    ZIP 75149
  • Facility Phone: 972 288-6403
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTONIETTE PONEWASH
  • NPI Number: 1013080548
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001551
LAB Type Pharmacy
Facility Name KROGER PHARMACY 209
Street 525 N GALLOWAY
City MESQUITE
State TX
ZIP 75149
Phone 972 288-6403
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Pharmacy
Lab Director ANTONIETTE PONEWASH

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This page was last updated on: 6/4/2025