45D2005969 CLIA NUMBER - KROGER PHARMACY 893

Laboratory Demographics

  • CLIA Code: 45D2005969
  • Facility Name: KROGER PHARMACY 893
  • Facility Address: 1919 FAITHON P LUCAS BLVD
    MESQUITE, TX
    ZIP 75181
  • Facility Phone: 469 726-0013
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA HICKMAN
  • NPI Number: 1497828925
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2005969
LAB Type Pharmacy
Facility Name KROGER PHARMACY 893
Street 1919 FAITHON P LUCAS BLVD
City MESQUITE
State TX
ZIP 75181
Phone 469 726-0013
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2024
Certificate Expiration Date 4/7/2026
Facility Type Pharmacy
Lab Director LISA HICKMAN

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