45D2052102 CLIA NUMBER - KROGER PHARMACY #509 ATTN PHARMICIST IN CHARGE

Laboratory Demographics

  • CLIA Code: 45D2052102
  • Facility Name: KROGER PHARMACY #509 ATTN PHARMICIST IN CHARGE
  • Facility Address: 4901 MAPLE AVE
    DALLAS, TX
    ZIP 75235
  • Facility Phone: 972 725-1270
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHNNA DEES
  • NPI Number: 1265701742
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2052102
LAB Type Pharmacy
Facility Name KROGER PHARMACY #509 ATTN PHARMICIST IN CHARGE
Street 4901 MAPLE AVE
City DALLAS
State TX
ZIP 75235
Phone 972 725-1270
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 JOHNNA DEES

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