11D2098312 CLIA NUMBER - KROGER PHARMACY #464

Laboratory Demographics

  • CLIA Code: 11D2098312
  • Facility Name: KROGER PHARMACY #464
  • Facility Address: 4875 FLOYD RD, SW
    MABLETON, GA
    ZIP 30126
  • Facility Phone: 770 745-3108
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1033143888
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098312
LAB Type Pharmacy
Facility Name KROGER PHARMACY #464
Street 4875 FLOYD RD, SW
City MABLETON
State GA
ZIP 30126
Phone 770 745-3108
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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