11D2097096 CLIA NUMBER - KROGER PHARMACY #633

Laboratory Demographics

  • CLIA Code: 11D2097096
  • Facility Name: KROGER PHARMACY #633
  • Facility Address: 2000 HIGHWAY 155 N
    MCDONOUGH, GA
    ZIP 30252
  • Facility Phone: 770 954-4389
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1174557987
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2097096
LAB Type Pharmacy
Facility Name KROGER PHARMACY #633
Street 2000 HIGHWAY 155 N
City MCDONOUGH
State GA
ZIP 30252
Phone 770 954-4389
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2025
Certificate Expiration Date 6/8/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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