11D2098997 CLIA NUMBER - KROGER PHARMACY #657

Laboratory Demographics

  • CLIA Code: 11D2098997
  • Facility Name: KROGER PHARMACY #657
  • Facility Address: 2960 SHALLOWFORD RD
    MARIETTA, GA
    ZIP 30062
  • Facility Phone: 770 977-3640
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1811921620
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2098997
LAB Type Pharmacy
Facility Name KROGER PHARMACY #657
Street 2960 SHALLOWFORD RD
City MARIETTA
State GA
ZIP 30062
Phone 770 977-3640
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: 9/29/2025