45D2001854 CLIA NUMBER - KROGER PHARMACY 517

Laboratory Demographics

  • CLIA Code: 45D2001854
  • Facility Name: KROGER PHARMACY 517
  • Facility Address: 160 N COIT
    RICHARDSON, TX
    ZIP 75080
  • Facility Phone: 972 497-9339
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GHADA IBRAHIM
  • NPI Number: 1346313962
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001854
LAB Type Pharmacy
Facility Name KROGER PHARMACY 517
Street 160 N COIT
City RICHARDSON
State TX
ZIP 75080
Phone 972 497-9339
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Pharmacy
Lab Director GHADA IBRAHIM

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