11D2097315 CLIA NUMBER - KROGER PHARMACY #442

Laboratory Demographics

  • CLIA Code: 11D2097315
  • Facility Name: KROGER PHARMACY #442
  • Facility Address: 1720 MARS HILL RD
    ACWORTH, GA
    ZIP 30101
  • Facility Phone: 770 419-5495
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1518982297
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2097315
LAB Type Pharmacy
Facility Name KROGER PHARMACY #442
Street 1720 MARS HILL RD
City ACWORTH
State GA
ZIP 30101
Phone 770 419-5495
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: 6/4/2025