11D2097293 CLIA NUMBER - KROGER PHARMACY #438

Laboratory Demographics

  • CLIA Code: 11D2097293
  • Facility Name: KROGER PHARMACY #438
  • Facility Address: 4155 HIGHWAY 29/BEAVER RUIN
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 770 717-3044
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1952335770
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2097293
LAB Type Physician Office
Facility Name KROGER PHARMACY #438
Street 4155 HIGHWAY 29/BEAVER RUIN
City LILBURN
State GA
ZIP 30047
Phone 770 717-3044
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2025
Certificate Expiration Date 6/10/2027
Facility Type Physician Office
Lab Director CHUCK PAGE

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