45D2069754 CLIA NUMBER - KROGER PHARMACY #579 ATTN PHARMACIST IN CHARGE

Laboratory Demographics

  • CLIA Code: 45D2069754
  • Facility Name: KROGER PHARMACY #579 ATTN PHARMACIST IN CHARGE
  • Facility Address: 500 MARKETPLACE BLVD
    FORNEY, TX
    ZIP 75126
  • Facility Phone: 713 507-6276
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: JEFF LOESCH
  • NPI Number: 1366878134
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2069754
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #579 ATTN PHARMACIST IN CHARGE
Street 500 MARKETPLACE BLVD
City FORNEY
State TX
ZIP 75126
Phone 713 507-6276
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Other - RETAIL PHARMACY
Lab Director JEFF LOESCH

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