11D0984217 CLIA NUMBER - KROGER PHARMACY #629

Laboratory Demographics

  • CLIA Code: 11D0984217
  • Facility Name: KROGER PHARMACY #629
  • Facility Address: 125 EAST MAIN STREET, SE
    CARTERSVILLE, GA
    ZIP 30121
  • Facility Phone: 770 386-8160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1043244890
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0984217
LAB Type Pharmacy
Facility Name KROGER PHARMACY #629
Street 125 EAST MAIN STREET, SE
City CARTERSVILLE
State GA
ZIP 30121
Phone 770 386-8160
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