11D0982373 CLIA NUMBER - KROGER PHARMACY #455

Laboratory Demographics

  • CLIA Code: 11D0982373
  • Facility Name: KROGER PHARMACY #455
  • Facility Address: 1000 WHITLOCK AVENUE
    MARIETTA, GA
    ZIP 30064
  • Facility Phone: 770 496-7456
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1568496446
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0982373
LAB Type Pharmacy
Facility Name KROGER PHARMACY #455
Street 1000 WHITLOCK AVENUE
City MARIETTA
State GA
ZIP 30064
Phone 770 496-7456
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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