45D2001901 CLIA NUMBER - KROGER PHARMACY 870

Laboratory Demographics

  • CLIA Code: 45D2001901
  • Facility Name: KROGER PHARMACY 870
  • Facility Address: 3770 BELT LINE ROAD
    ADDISON, TX
    ZIP 75001
  • Facility Phone: 972 620-0349
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY TAN
  • NPI Number: 1124191655
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2001901
LAB Type Pharmacy
Facility Name KROGER PHARMACY 870
Street 3770 BELT LINE ROAD
City ADDISON
State TX
ZIP 75001
Phone 972 620-0349
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 AMY TAN

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