11D2098550 CLIA NUMBER - KROGER PHARMACY #616

Laboratory Demographics

  • CLIA Code: 11D2098550
  • Facility Name: KROGER PHARMACY #616
  • Facility Address: 4815 RIDGE ROAD
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 000 770-9492
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1063446870
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098550
LAB Type Pharmacy
Facility Name KROGER PHARMACY #616
Street 4815 RIDGE ROAD
City DOUGLASVILLE
State GA
ZIP 30134
Phone 000 770-9492
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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