11D2097309 CLIA NUMBER - KROGER PHARMACY #439

Laboratory Demographics

  • CLIA Code: 11D2097309
  • Facility Name: KROGER PHARMACY #439
  • Facility Address: 1606 MEMORIAL DRIVE
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 912 287-2277
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1902830748
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2097309
LAB Type Pharmacy
Facility Name KROGER PHARMACY #439
Street 1606 MEMORIAL DRIVE
City WAYCROSS
State GA
ZIP 31501
Phone 912 287-2277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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