51D1075302 CLIA NUMBER - KROGER PHARMACY #788

Laboratory Demographics

  • CLIA Code: 51D1075302
  • Facility Name: KROGER PHARMACY #788
  • Facility Address: 6360 US ROUTE 60
    BARBOURSVILLE, WV
    ZIP 25504
  • Facility Phone: (304) 733-3373
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1336173129
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1075302
LAB Type Physician Office
Facility Name KROGER PHARMACY #788
Street 6360 US ROUTE 60
City BARBOURSVILLE
State WV
ZIP 25504
Phone 3047333373
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 Physician Office
Lab Director CHRIS KOON

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This page was last updated on: 5/18/2026