11D0983365 CLIA NUMBER - KROGER PHARMACY 394

Laboratory Demographics

  • CLIA Code: 11D0983365
  • Facility Name: KROGER PHARMACY 394
  • Facility Address: 3050 FIVE FORKS TRICKUM ROAD
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 770 985-3720
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1619992393
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0983365
LAB Type Pharmacy
Facility Name KROGER PHARMACY 394
Street 3050 FIVE FORKS TRICKUM ROAD
City LILBURN
State GA
ZIP 30047
Phone 770 985-3720
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