11D0984212 CLIA NUMBER - KROGER PHARMACY NUMBER #411

Laboratory Demographics

  • CLIA Code: 11D0984212
  • Facility Name: KROGER PHARMACY NUMBER #411
  • Facility Address: 4628 PRESIDENTIAL PARKWAY
    MACON, GA
    ZIP 31206
  • Facility Phone: 478 405-3915
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1356375166
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0984212
LAB Type Pharmacy
Facility Name KROGER PHARMACY NUMBER #411
Street 4628 PRESIDENTIAL PARKWAY
City MACON
State GA
ZIP 31206
Phone 478 405-3915
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