51D1075301 CLIA NUMBER - KROGER PHARMACY #029-734

Laboratory Demographics

  • CLIA Code: 51D1075301
  • Facility Name: KROGER PHARMACY #029-734
  • Facility Address: 406 RAINE DR
    RAINELLE, WV
    ZIP 25962
  • Facility Phone: 304 438-7182
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1225062011
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1075301
LAB Type Pharmacy
Facility Name KROGER PHARMACY #029-734
Street 406 RAINE DR
City RAINELLE
State WV
ZIP 25962
Phone 304 438-7182
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

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