11D2098479 CLIA NUMBER - KROGER PHARMACY #492

Laboratory Demographics

  • CLIA Code: 11D2098479
  • Facility Name: KROGER PHARMACY #492
  • Facility Address: 5664 JONESBORO ROAD
    LAKE CITY, GA
    ZIP 30260
  • Facility Phone: 770 960-0162
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1093749988
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098479
LAB Type Pharmacy
Facility Name KROGER PHARMACY #492
Street 5664 JONESBORO ROAD
City LAKE CITY
State GA
ZIP 30260
Phone 770 960-0162
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