11D2023791 CLIA NUMBER - KROGER PHARMACY #355

Laboratory Demographics

  • CLIA Code: 11D2023791
  • Facility Name: KROGER PHARMACY #355
  • Facility Address: 4650 FORSYTH ROAD
    MACON, GA
    ZIP 31201
  • Facility Phone: 770 496-7456
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1497789226
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2023791
LAB Type Pharmacy
Facility Name KROGER PHARMACY #355
Street 4650 FORSYTH ROAD
City MACON
State GA
ZIP 31201
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