11D0984297 CLIA NUMBER - KROGER PHARMACY #414

Laboratory Demographics

  • CLIA Code: 11D0984297
  • Facility Name: KROGER PHARMACY #414
  • Facility Address: 4355 WASHINGTON AVENUE
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 868-4515
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LIZA CHAPMAN
  • NPI Number: 1427082254
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0984297
LAB Type Pharmacy
Facility Name KROGER PHARMACY #414
Street 4355 WASHINGTON AVENUE
City EVANS
State GA
ZIP 30809
Phone 706 868-4515
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 LIZA CHAPMAN

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This page was last updated on: 9/29/2025