11D2098260 CLIA NUMBER - KROGER PHARMACY #458

Laboratory Demographics

  • CLIA Code: 11D2098260
  • Facility Name: KROGER PHARMACY #458
  • Facility Address: 1365 WEST WALNUT AVE
    DALTON, GA
    ZIP 30720
  • Facility Phone: 404 294-8211
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1548294432
  • Taxonomy: 3336C0003X - Pharmacy

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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
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