11D2098260 CLIA NUMBER - KROGER PHARMACY #458

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Laboratory Demographics

CLIA Number: 11D2098260

Facility Name: KROGER PHARMACY #458

Facility Address:
1365 WEST WALNUT AVE
DALTON, GA
ZIP 30720
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Facility Phone Number: 404 294-8211

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1548294432

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	11D2098260
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #458
Street	1365 WEST WALNUT AVE
City	DALTON
State	GA
ZIP	30720
Phone	404 294-8211
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