11D2032984 CLIA NUMBER - KROGER PHARMACY #482

Laboratory Demographics

  • CLIA Code: 11D2032984
  • Facility Name: KROGER PHARMACY #482
  • Facility Address: 4357 LAWRENCEVILLE HIGHWAY
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 934-8322
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK G. PAGE
  • NPI Number: 1952335861
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2032984
LAB Type Pharmacy
Facility Name KROGER PHARMACY #482
Street 4357 LAWRENCEVILLE HIGHWAY
City TUCKER
State GA
ZIP 30084
Phone 770 934-8322
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Pharmacy
Lab Director CHUCK G. PAGE

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