11D0989577 CLIA NUMBER - KROGER PHARMACY #475

Laboratory Demographics

  • CLIA Code: 11D0989577
  • Facility Name: KROGER PHARMACY #475
  • Facility Address: 4919 FLAT SHOALS PKWY
    DECATUR, GA
    ZIP 30034
  • Facility Phone: 770 322-3138
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1376577189
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0989577
LAB Type Pharmacy
Facility Name KROGER PHARMACY #475
Street 4919 FLAT SHOALS PKWY
City DECATUR
State GA
ZIP 30034
Phone 770 322-3138
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