49D1069345 CLIA NUMBER - KROGER PHARMACY

Laboratory Demographics

  • CLIA Code: 49D1069345
  • Facility Name: KROGER PHARMACY
  • Facility Address: 4625 SHORE DRIVE
    VIRGINIA BEACH, VA
    ZIP 23455
  • Facility Phone: 540 563-3321
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELE FOUNTAIN
  • NPI Number: 1043244817
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D1069345
LAB Type Pharmacy
Facility Name KROGER PHARMACY
Street 4625 SHORE DRIVE
City VIRGINIA BEACH
State VA
ZIP 23455
Phone 540 563-3321
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2025
Certificate Expiration Date 5/31/2027
Facility Type Pharmacy
Lab Director MICHELE FOUNTAIN

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