45D2001886 CLIA NUMBER - KROGER PHARMACY 575

Laboratory Demographics

  • CLIA Code: 45D2001886
  • Facility Name: KROGER PHARMACY 575
  • Facility Address: 2935 RIDGE ROAD
    ROCKWALL, TX
    ZIP 75032
  • Facility Phone: 972 771-3208
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL M. SIMONS
  • NPI Number: 1568535185
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001886
LAB Type Pharmacy
Facility Name KROGER PHARMACY 575
Street 2935 RIDGE ROAD
City ROCKWALL
State TX
ZIP 75032
Phone 972 771-3208
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 DANIEL M. SIMONS

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