51D1026622 CLIA NUMBER - KROGER PHARMACY 029-794

Laboratory Demographics

  • CLIA Code: 51D1026622
  • Facility Name: KROGER PHARMACY 029-794
  • Facility Address: 101 GREAT TEAYS BLVD
    SCOTT DEPOT, WV
    ZIP 25560
  • Facility Phone: 304 757-8952
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1124052907
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 51D1026622
LAB Type Pharmacy
Facility Name KROGER PHARMACY 029-794
Street 101 GREAT TEAYS BLVD
City SCOTT DEPOT
State WV
ZIP 25560
Phone 304 757-8952
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Pharmacy
Lab Director CHRIS KOON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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