11D2023791 CLIA NUMBER - KROGER PHARMACY #355

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Laboratory Demographics

CLIA Number: 11D2023791

Facility Name: KROGER PHARMACY #355

Facility Address:
4650 FORSYTH ROAD
MACON, GA
ZIP 31201
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Facility Phone Number: 770 496-7456

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1497789226

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	11D2023791
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #355
Street	4650 FORSYTH ROAD
City	MACON
State	GA
ZIP	31201
Phone	770 496-7456
CertificateType	4
CertificateEffectiveDate	5/2/2023
CertificateExpirationDate	5/1/2025
FacilityType	Waiver

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