11D1066586 CLIA NUMBER - KROGER PHARMACY #011-638

Laboratory Demographics

CLIA Number: 11D1066586

Facility Name: KROGER PHARMACY #011-638

Facility Address:
1685 OLD PENDERGRASS ROAD
JEFFERSON, GA
ZIP 30549
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Facility Phone Number: 706 387-7620

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1912028267

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	11D1066586
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #011-638
Street	1685 OLD PENDERGRASS ROAD
City	JEFFERSON
State	GA
ZIP	30549
Phone	706 387-7620
CertificateType	4
CertificateEffectiveDate	3/28/2023
CertificateExpirationDate	3/27/2025
FacilityType	Waiver

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