49D1059507 CLIA NUMBER - KROGER PHARMACY #29-408

Laboratory Demographics

  • CLIA Code: 49D1059507
  • Facility Name: KROGER PHARMACY #29-408
  • Facility Address: 4119 BOONESBORO ROAD
    LYNCHBURG, VA
    ZIP 24503
  • Facility Phone: 434 384-3666
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA BROOKHART
  • NPI Number: 1184649881
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D1059507
LAB Type Pharmacy
Facility Name KROGER PHARMACY #29-408
Street 4119 BOONESBORO ROAD
City LYNCHBURG
State VA
ZIP 24503
Phone 434 384-3666
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Pharmacy
Lab Director ANDREA BROOKHART

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