11D0983258 CLIA NUMBER - KROGER PHARMACY #427

Laboratory Demographics

  • CLIA Code: 11D0983258
  • Facility Name: KROGER PHARMACY #427
  • Facility Address: 101 FAIRVIEW ROAD
    ELLENWOOD, GA
    ZIP 30294
  • Facility Phone: 770 389-7088
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1639103476
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983258
LAB Type Pharmacy
Facility Name KROGER PHARMACY #427
Street 101 FAIRVIEW ROAD
City ELLENWOOD
State GA
ZIP 30294
Phone 770 389-7088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/15/2024
Certificate Expiration Date 9/14/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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