11D2096107 CLIA NUMBER - KROGER PHARMACY #431

Laboratory Demographics

  • CLIA Code: 11D2096107
  • Facility Name: KROGER PHARMACY #431
  • Facility Address: 570 EAST CROSSVILLE ROAD
    ROSWELL, GA
    ZIP 30076
  • Facility Phone: 770 640-2065
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1376568154
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2096107
LAB Type Pharmacy
Facility Name KROGER PHARMACY #431
Street 570 EAST CROSSVILLE ROAD
City ROSWELL
State GA
ZIP 30076
Phone 770 640-2065
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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