45D2001581 CLIA NUMBER - KROGER PHARMACY 429

Laboratory Demographics

  • CLIA Code: 45D2001581
  • Facility Name: KROGER PHARMACY 429
  • Facility Address: 2201 W GRAUWYLER ROAD
    IRVING, TX
    ZIP 75061
  • Facility Phone: 972 790-5747
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH CHARLES
  • NPI Number: 1811060346
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001581
LAB Type Pharmacy
Facility Name KROGER PHARMACY 429
Street 2201 W GRAUWYLER ROAD
City IRVING
State TX
ZIP 75061
Phone 972 790-5747
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 KENNETH CHARLES

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