11D0983259 CLIA NUMBER - KROGER PHARMACY #420

Laboratory Demographics

  • CLIA Code: 11D0983259
  • Facility Name: KROGER PHARMACY #420
  • Facility Address: 3150 EAST HIGHWAY 34
    NEWNAN, GA
    ZIP 30265
  • Facility Phone: 770 254-3035
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1417981119
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983259
LAB Type Pharmacy
Facility Name KROGER PHARMACY #420
Street 3150 EAST HIGHWAY 34
City NEWNAN
State GA
ZIP 30265
Phone 770 254-3035
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