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11D0989577 CLIA NUMBER - KROGER PHARMACY #475

Laboratory Demographics

CLIA Number: 11D0989577

Facility Name: KROGER PHARMACY #475

Facility Address:
4919 FLAT SHOALS PKWY
DECATUR, GA
ZIP 30034
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Facility Phone Number: 770 322-3138

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1376577189

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 11D0989577
LAB Type Pharmacy
Facility Name KROGER PHARMACY #475
Street 4919 FLAT SHOALS PKWY
City DECATUR
State GA
ZIP 30034
Phone 770 322-3138
CertificateType 4
CertificateEffectiveDate 12/17/2022
CertificateExpirationDate 12/16/2024
FacilityType Waiver

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