51D1062100 CLIA NUMBER - KROGER PHARMACY #029-774

Laboratory Demographics

  • CLIA Code: 51D1062100
  • Facility Name: KROGER PHARMACY #029-774
  • Facility Address: 102 EMILY DRIVE
    CLARKSBURG, WV
    ZIP 26301
  • Facility Phone: 304 623-1482
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1306870183
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1062100
LAB Type Pharmacy
Facility Name KROGER PHARMACY #029-774
Street 102 EMILY DRIVE
City CLARKSBURG
State WV
ZIP 26301
Phone 304 623-1482
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2024
Certificate Expiration Date 12/4/2026
Facility Type Pharmacy
Lab Director CHRIS KOON

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