11D2064143 CLIA NUMBER - KROGER PHARMACY #210

Laboratory Demographics

  • CLIA Code: 11D2064143
  • Facility Name: KROGER PHARMACY #210
  • Facility Address: 4498 CHAMBLEE DUNWOODY ROAD
    DUNWOODY, GA
    ZIP 30338
  • Facility Phone: 770 451-7408
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1639103526
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2064143
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #210
Street 4498 CHAMBLEE DUNWOODY ROAD
City DUNWOODY
State GA
ZIP 30338
Phone 770 451-7408
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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