11D0990509 CLIA NUMBER - KROGER PHARMACY #413

Laboratory Demographics

  • CLIA Code: 11D0990509
  • Facility Name: KROGER PHARMACY #413
  • Facility Address: 10375 TARA BLVD
    JONESBORO, GA
    ZIP 30236
  • Facility Phone: 770 477-0975
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1457385262
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0990509
LAB Type Pharmacy
Facility Name KROGER PHARMACY #413
Street 10375 TARA BLVD
City JONESBORO
State GA
ZIP 30236
Phone 770 477-0975
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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This page was last updated on: 6/4/2025