51D1075293 CLIA NUMBER - KROGER PHARMACY # 754

Laboratory Demographics

  • CLIA Code: 51D1075293
  • Facility Name: KROGER PHARMACY # 754
  • Facility Address: 10635 MACCORKLE AVENUE
    MARMET, WV
    ZIP 25315
  • Facility Phone: 304 949-3045
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1689608465
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 51D1075293
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 754
Street 10635 MACCORKLE AVENUE
City MARMET
State WV
ZIP 25315
Phone 304 949-3045
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2025
Certificate Expiration Date 10/16/2027
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