11D2098205 CLIA NUMBER - KROGER PHARMACY #449

Laboratory Demographics

  • CLIA Code: 11D2098205
  • Facility Name: KROGER PHARMACY #449
  • Facility Address: 1227 ROCKBRIDGE RD
    STONE MOUNTAIN, GA
    ZIP 30087
  • Facility Phone: 770 225-1888
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1326072133
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098205
LAB Type Pharmacy
Facility Name KROGER PHARMACY #449
Street 1227 ROCKBRIDGE RD
City STONE MOUNTAIN
State GA
ZIP 30087
Phone 770 225-1888
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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