11D2098259 CLIA NUMBER - KROGER PHARMACY #456

Laboratory Demographics

  • CLIA Code: 11D2098259
  • Facility Name: KROGER PHARMACY #456
  • Facility Address: 4400 BROWNSVILLE
    POWDER SPRINGS, GA
    ZIP 30127
  • Facility Phone: 770 222-4205
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1255365060
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098259
LAB Type Pharmacy
Facility Name KROGER PHARMACY #456
Street 4400 BROWNSVILLE
City POWDER SPRINGS
State GA
ZIP 30127
Phone 770 222-4205
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