49D2106519 CLIA NUMBER - KROGER PHARMACY#401

Laboratory Demographics

CLIA Number: 49D2106519

Facility Name: KROGER PHARMACY#401

Facility Address:
4375 BRAMBLETON AVENUE
ROANOKE, VA
ZIP 24018
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Facility Phone Number: 540 772-0605

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1063896991

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	49D2106519
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY#401
Street	4375 BRAMBLETON AVENUE
City	ROANOKE
State	VA
ZIP	24018
Phone	540 772-0605
CertificateType	4
CertificateEffectiveDate	12/21/2023
CertificateExpirationDate	12/20/2025
FacilityType	Waiver

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