11D0984216 CLIA NUMBER - KROGER PHARMACY #294

Laboratory Demographics

  • CLIA Code: 11D0984216
  • Facility Name: KROGER PHARMACY #294
  • Facility Address: 4115 COLUMBIA ROAD
    MARTINEZ, GA
    ZIP 30907
  • Facility Phone: 706 863-9645
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1942234794
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0984216
LAB Type Pharmacy
Facility Name KROGER PHARMACY #294
Street 4115 COLUMBIA ROAD
City MARTINEZ
State GA
ZIP 30907
Phone 706 863-9645
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: 9/29/2025