11D2097109 CLIA NUMBER - KROGER PHARMACY #436

Laboratory Demographics

  • CLIA Code: 11D2097109
  • Facility Name: KROGER PHARMACY #436
  • Facility Address: 5341 HIGHWAY 20 SOUTH
    COVINGTON, GA
    ZIP 30016
  • Facility Phone: 770 788-4008
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1457385296
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2097109
LAB Type Pharmacy
Facility Name KROGER PHARMACY #436
Street 5341 HIGHWAY 20 SOUTH
City COVINGTON
State GA
ZIP 30016
Phone 770 788-4008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2023
Certificate Expiration Date 6/8/2025
Facility Type Pharmacy
Lab Director CHUCK PAGE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025