11D0983275 CLIA NUMBER - KROGER PHARMACY #476

Laboratory Demographics

  • CLIA Code: 11D0983275
  • Facility Name: KROGER PHARMACY #476
  • Facility Address: 6555 SUGARLOAF PARKWAY SUITE 200
    DULUTH, GA
    ZIP 30097
  • Facility Phone: 770 418-2398
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1720012610
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983275
LAB Type Pharmacy
Facility Name KROGER PHARMACY #476
Street 6555 SUGARLOAF PARKWAY SUITE 200
City DULUTH
State GA
ZIP 30097
Phone 770 418-2398
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: 3/20/2025