45D2001865 CLIA NUMBER - KROGER PHARMACY 536

Laboratory Demographics

  • CLIA Code: 45D2001865
  • Facility Name: KROGER PHARMACY 536
  • Facility Address: 6650 N BEACH
    FORT WORTH, TX
    ZIP 76137
  • Facility Phone: 817 788-1757
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORGE PIEDRA
  • NPI Number: 1437222056
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001865
LAB Type Pharmacy
Facility Name KROGER PHARMACY 536
Street 6650 N BEACH
City FORT WORTH
State TX
ZIP 76137
Phone 817 788-1757
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 JORGE PIEDRA

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