45D2092316 CLIA NUMBER - KROGER PHARMACY #917

Laboratory Demographics

  • CLIA Code: 45D2092316
  • Facility Name: KROGER PHARMACY #917
  • Facility Address: 3915 HIGHWAY 377 EAST
    GRANBURY, TX
    ZIP 76049
  • Facility Phone: 713 507-6276
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: BRANDI D. KULCZYCKI
  • NPI Number: 1720477888
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2092316
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #917
Street 3915 HIGHWAY 377 EAST
City GRANBURY
State TX
ZIP 76049
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 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Other - RETAIL PHARMACY
Lab Director BRANDI D. KULCZYCKI

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