49D1093721 CLIA NUMBER - KROGER PHARMACY 029-537

Laboratory Demographics

  • CLIA Code: 49D1093721
  • Facility Name: KROGER PHARMACY 029-537
  • Facility Address: 975 PROVIDENCE ROAD
    VIRGINIA BEACH, VA
    ZIP 23464
  • Facility Phone: 757 495-9713
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1881628667
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D1093721
LAB Type Pharmacy
Facility Name KROGER PHARMACY 029-537
Street 975 PROVIDENCE ROAD
City VIRGINIA BEACH
State VA
ZIP 23464
Phone 757 495-9713
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2024
Certificate Expiration Date 12/29/2026
Facility Type Pharmacy
Lab Director CHRIS KOON

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