45D2052095 CLIA NUMBER - KROGER PHARMACY #529 ATTN PHARMICIST IN CHARGE

Laboratory Demographics

  • CLIA Code: 45D2052095
  • Facility Name: KROGER PHARMACY #529 ATTN PHARMICIST IN CHARGE
  • Facility Address: 4241 CAPITOL AVE
    DALLAS, TX
    ZIP 75204
  • Facility Phone: 972 338-3101
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIEN VU
  • NPI Number: 1417212820
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2052095
LAB Type Pharmacy
Facility Name KROGER PHARMACY #529 ATTN PHARMICIST IN CHARGE
Street 4241 CAPITOL AVE
City DALLAS
State TX
ZIP 75204
Phone 972 338-3101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Pharmacy
Lab Director DIEN VU

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