11D2053179 CLIA NUMBER - KROGER PHARMACY #619

Laboratory Demographics

  • CLIA Code: 11D2053179
  • Facility Name: KROGER PHARMACY #619
  • Facility Address: 1524 GEORGIA HIGHWAY 16W
    GRIFFIN, GA
    ZIP 30223
  • Facility Phone: 770 496-7400
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1629321823
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2053179
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #619
Street 1524 GEORGIA HIGHWAY 16W
City GRIFFIN
State GA
ZIP 30223
Phone 770 496-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2025
Certificate Expiration Date 1/27/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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