Healther Providers Data Logo

11D0984274 CLIA NUMBER - KROGER PHARMACY #400

Laboratory Demographics

CLIA Number: 11D0984274

Facility Name: KROGER PHARMACY #400

Facility Address:
4321 HARTLEY BRIDGE ROAD
MACON, GA
ZIP 31216
Get Directions

Facility Phone Number: 478 788-1015

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1568496305

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 11D0984274
LAB Type Pharmacy
Facility Name KROGER PHARMACY #400
Street 4321 HARTLEY BRIDGE ROAD
City MACON
State GA
ZIP 31216
Phone 478 788-1015
CertificateType 4
CertificateEffectiveDate 9/15/2022
CertificateExpirationDate 9/14/2024
FacilityType Waiver

Download Record

Download this CLIA NUMBER record in Text format: Export

Download this CLIA NUMBER record in Excel (CSV) format: Export

Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024