45D2120762 CLIA NUMBER - KROGER PHARMACY #574

Laboratory Demographics

  • CLIA Code: 45D2120762
  • Facility Name: KROGER PHARMACY #574
  • Facility Address: 1950 GOLIAD ST5REET
    ROCKWALL, TX
    ZIP 75087
  • Facility Phone: 713 507-6276
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHARLENE FORD
  • NPI Number: 1043660319
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2120762
LAB Type Other - PHARMACY
Facility Name KROGER PHARMACY #574
Street 1950 GOLIAD ST5REET
City ROCKWALL
State TX
ZIP 75087
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 10/24/2024
Certificate Expiration Date 10/23/2026
Facility Type Other - PHARMACY
Lab Director CHARLENE FORD

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