51D1058117 CLIA NUMBER - KROGER PHARMACY #977

Laboratory Demographics

  • CLIA Code: 51D1058117
  • Facility Name: KROGER PHARMACY #977
  • Facility Address: 1300 LAFAYETTE AVENUE
    MOUNDSVILLE, WV
    ZIP 26041
  • Facility Phone: 304 845-8298
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TARA R. GREEN
  • NPI Number: 1851325641
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1058117
LAB Type Pharmacy
Facility Name KROGER PHARMACY #977
Street 1300 LAFAYETTE AVENUE
City MOUNDSVILLE
State WV
ZIP 26041
Phone 304 845-8298
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2024
Certificate Expiration Date 8/29/2026
Facility Type Pharmacy
Lab Director TARA R. GREEN

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