11D0983279 CLIA NUMBER - KROGER PHARMACY

Laboratory Demographics

  • CLIA Code: 11D0983279
  • Facility Name: KROGER PHARMACY
  • Facility Address: 3875 CHAPEL HILL ROAD
    DOUGLASVILLE, GA
    ZIP 30135
  • Facility Phone: (770) 947-8787
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1194759076
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983279
LAB Type Pharmacy
Facility Name KROGER PHARMACY
Street 3875 CHAPEL HILL ROAD
City DOUGLASVILLE
State GA
ZIP 30135
Phone 7709478787
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: 5/18/2026