51D1075303 CLIA NUMBER - KROGER PHARMACY #785

Laboratory Demographics

  • CLIA Code: 51D1075303
  • Facility Name: KROGER PHARMACY #785
  • Facility Address: 1100 FLEDDERJOHN ROAD
    CHARLESTON, WV
    ZIP 25314
  • Facility Phone: 304 342-8832
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1851325633
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1075303
LAB Type Physician Office
Facility Name KROGER PHARMACY #785
Street 1100 FLEDDERJOHN ROAD
City CHARLESTON
State WV
ZIP 25314
Phone 304 342-8832
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: 9/29/2025