11D1007926 CLIA NUMBER - KROGER PHARMACY #462

Laboratory Demographics

  • CLIA Code: 11D1007926
  • Facility Name: KROGER PHARMACY #462
  • Facility Address: 3030 HEADLAND DRIVE
    ATLANTA, GA
    ZIP 30311
  • Facility Phone: 770 496-7456
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1649204454
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D1007926
LAB Type Pharmacy
Facility Name KROGER PHARMACY #462
Street 3030 HEADLAND DRIVE
City ATLANTA
State GA
ZIP 30311
Phone 770 496-7456
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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