45D2001895 CLIA NUMBER - KROGER PHARMACY 817

Laboratory Demographics

  • CLIA Code: 45D2001895
  • Facility Name: KROGER PHARMACY 817
  • Facility Address: 2525 W I-20
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 988-1366
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RENCY SAMUEL
  • NPI Number: 1306919626
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001895
LAB Type Pharmacy
Facility Name KROGER PHARMACY 817
Street 2525 W I-20
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 988-1366
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 RENCY SAMUEL

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