11D2053179 CLIA NUMBER - KROGER PHARMACY #619

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Laboratory Demographics

CLIA Number: 11D2053179

Facility Name: KROGER PHARMACY #619

Facility Address:
1524 GEORGIA HIGHWAY 16W
GRIFFIN, GA
ZIP 30223
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Facility Phone Number: 770 496-7400

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1629321823

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	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
CertificateType	4
CertificateEffectiveDate	1/28/2023
CertificateExpirationDate	1/27/2025
FacilityType	Waiver

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