51D1094908 CLIA NUMBER - KROGER PHARMACY # 772

Laboratory Demographics

  • CLIA Code: 51D1094908
  • Facility Name: KROGER PHARMACY # 772
  • Facility Address: 5717 MACCORKLE AVENUE SE
    CHARLESTON, WV
    ZIP 25304
  • Facility Phone: 304 925-8400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1770517559
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D1094908
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 772
Street 5717 MACCORKLE AVENUE SE
City CHARLESTON
State WV
ZIP 25304
Phone 304 925-8400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2025
Certificate Expiration Date 1/28/2027
Facility Type Pharmacy
Lab Director CHRIS KOON

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