15D1077793 CLIA NUMBER - KROGER PHARMACY #915

Laboratory Demographics

  • CLIA Code: 15D1077793
  • Facility Name: KROGER PHARMACY #915
  • Facility Address: 901 JOHNSON ST
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 264-5996
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TATIANA MC CLEARY
  • NPI Number: 1861565483
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D1077793
LAB Type Pharmacy
Facility Name KROGER PHARMACY #915
Street 901 JOHNSON ST
City ELKHART
State IN
ZIP 46514
Phone 574 264-5996
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Pharmacy
Lab Director TATIANA MC CLEARY

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This page was last updated on: 6/4/2025