11D2007644 CLIA NUMBER - KROGER PHARMACY #339

Laboratory Demographics

  • CLIA Code: 11D2007644
  • Facility Name: KROGER PHARMACY #339
  • Facility Address: 203-A COMMERCE STREET
    LAGRANGE, GA
    ZIP 30240
  • Facility Phone: 706 883-6178
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1407880230
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2007644
LAB Type Pharmacy
Facility Name KROGER PHARMACY #339
Street 203-A COMMERCE STREET
City LAGRANGE
State GA
ZIP 30240
Phone 706 883-6178
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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