51D2009588 CLIA NUMBER - KROGER PHARMACY # 817

Laboratory Demographics

  • CLIA Code: 51D2009588
  • Facility Name: KROGER PHARMACY # 817
  • Facility Address: 3265 SMOOT AVENUE
    MADISON, WV
    ZIP 25130
  • Facility Phone: 304 369-9074
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS KOON
  • NPI Number: 1063446854
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2009588
LAB Type Pharmacy
Facility Name KROGER PHARMACY # 817
Street 3265 SMOOT AVENUE
City MADISON
State WV
ZIP 25130
Phone 304 369-9074
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