11D2098984 CLIA NUMBER - KROGER PHARMACY #641

Laboratory Demographics

  • CLIA Code: 11D2098984
  • Facility Name: KROGER PHARMACY #641
  • Facility Address: 774 HIGHWAY 96
    BONAIRE, GA
    ZIP 31005
  • Facility Phone: (478) 988-5720
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1912232927
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098984
LAB Type Pharmacy
Facility Name KROGER PHARMACY #641
Street 774 HIGHWAY 96
City BONAIRE
State GA
ZIP 31005
Phone 4789885720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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This page was last updated on: 5/18/2026