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45D2001585 CLIA NUMBER - KROGER PHARMACY 450

Laboratory Demographics

CLIA Number: 45D2001585

Facility Name: KROGER PHARMACY 450

Facility Address:
3600 GUS THOMASSON ROAD
MESQUITE, TX
ZIP 75150
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Facility Phone Number: 972 270-2401

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1356711873

Taxonomy: 183500000X - Pharmacist
An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

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
CertificateType 4
CertificateEffectiveDate 12/22/2023
CertificateExpirationDate 12/21/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024