51D2009586 CLIA NUMBER - KROGER PHARMACY # 763

Laboratory Demographics

  • CLIA Code: 51D2009586
  • Facility Name: KROGER PHARMACY # 763
  • Facility Address: 5450 BIG TYLER ROAD
    CROSS LANES, WV
    ZIP 25313
  • Facility Phone: 304 776-5178
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1043244825
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2009586
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 763
Street 5450 BIG TYLER ROAD
City CROSS LANES
State WV
ZIP 25313
Phone 304 776-5178
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type Pharmacy
Lab Director CHRIS KOON

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