11D2098464 CLIA NUMBER - KROGER PHARMACY #484

Laboratory Demographics

  • CLIA Code: 11D2098464
  • Facility Name: KROGER PHARMACY #484
  • Facility Address: 3035 CENTERVILLE HIGHWAY SUITE 19
    SNELLVILLE, GA
    ZIP 30039
  • Facility Phone: 770 982-1061
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1043244957
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098464
LAB Type Pharmacy
Facility Name KROGER PHARMACY #484
Street 3035 CENTERVILLE HIGHWAY SUITE 19
City SNELLVILLE
State GA
ZIP 30039
Phone 770 982-1061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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