45D2120940 CLIA NUMBER - KROGER PHARMACY #576

Laboratory Demographics

  • CLIA Code: 45D2120940
  • Facility Name: KROGER PHARMACY #576
  • Facility Address: 4750 W BAILEY BOSWELL ROAD
    FORT WORTH, TX
    ZIP 76179
  • Facility Phone: 281 670-2058
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: MARIBETH FINN
  • NPI Number: 1275081960
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2120940
LAB Type Other - PHARMACY
Facility Name KROGER PHARMACY #576
Street 4750 W BAILEY BOSWELL ROAD
City FORT WORTH
State TX
ZIP 76179
Phone 281 670-2058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Other - PHARMACY
Lab Director MARIBETH FINN

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