11D2095892 CLIA NUMBER - KROGER PHARMACY #212

Laboratory Demographics

  • CLIA Code: 11D2095892
  • Facility Name: KROGER PHARMACY #212
  • Facility Address: 3959 A LAVISTA RD
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 934-6442
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1821013525
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2095892
LAB Type Pharmacy
Facility Name KROGER PHARMACY #212
Street 3959 A LAVISTA RD
City TUCKER
State GA
ZIP 30084
Phone 770 934-6442
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2025
Certificate Expiration Date 5/12/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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