11D0983261 CLIA NUMBER - KROGER PHARMACY # 376

Laboratory Demographics

  • CLIA Code: 11D0983261
  • Facility Name: KROGER PHARMACY # 376
  • Facility Address: 630 THORNTON ROAD
    LITHIA SPRINGS, GA
    ZIP 30122
  • Facility Phone: 770 732-6995
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1831123678
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983261
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY # 376
Street 630 THORNTON ROAD
City LITHIA SPRINGS
State GA
ZIP 30122
Phone 770 732-6995
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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