45D2008528 CLIA NUMBER - KROGER PHARMACY 520

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Laboratory Demographics

CLIA Number: 45D2008528

Facility Name: KROGER PHARMACY 520

Facility Address:
3120 S UNIVERSITY
FORT WORTH, TX
ZIP 76109
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Facility Phone Number: 817 566-7861

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1225352230

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	45D2008528
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY 520
Street	3120 S UNIVERSITY
City	FORT WORTH
State	TX
ZIP	76109
Phone	817 566-7861
CertificateType	4
CertificateEffectiveDate	6/11/2022
CertificateExpirationDate	6/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024