45D2001585 CLIA NUMBER - KROGER PHARMACY 450

Laboratory Demographics

  • CLIA Code: 45D2001585
  • Facility Name: KROGER PHARMACY 450
  • Facility Address: 3600 GUS THOMASSON ROAD
    MESQUITE, TX
    ZIP 75150
  • Facility Phone: 972 270-2401
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA HICKMAN
  • NPI Number: 1356711873
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 45D2001585
LAB Type Pharmacy
Facility Name KROGER PHARMACY 450
Street 3600 GUS THOMASSON ROAD
City MESQUITE
State TX
ZIP 75150
Phone 972 270-2401
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 LISA HICKMAN

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