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49D1078317 CLIA NUMBER - KROGER PHARMACY #400

Laboratory Demographics

CLIA Number: 49D1078317

Facility Name: KROGER PHARMACY #400

Facility Address:
614 BRANDON AVENUE
ROANOKE, VA
ZIP 24015
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Facility Phone Number: 540 342-9897

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1063446847

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 49D1078317
LAB Type Pharmacy
Facility Name KROGER PHARMACY #400
Street 614 BRANDON AVENUE
City ROANOKE
State VA
ZIP 24015
Phone 540 342-9897
CertificateType 4
CertificateEffectiveDate 1/7/2024
CertificateExpirationDate 1/6/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024