11D2098252 CLIA NUMBER - KROGER PHARMACY #454

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Laboratory Demographics

CLIA Number: 11D2098252

Facility Name: KROGER PHARMACY #454

Facility Address:
2100 ROSWELL RD, NE SUITE 2140
MARIETTA, GA
ZIP 30060
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Facility Phone Number: 770 321-1088

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1427073105

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2098252
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #454
Street	2100 ROSWELL RD, NE SUITE 2140
City	MARIETTA
State	GA
ZIP	30060
Phone	770 321-1088
CertificateType	4
CertificateEffectiveDate	7/2/2023
CertificateExpirationDate	7/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024