11D2099004 CLIA NUMBER - KROGER PHARMACY #673

Laboratory Demographics

  • CLIA Code: 11D2099004
  • Facility Name: KROGER PHARMACY #673
  • Facility Address: 457 NATHAN DEAN BLVD
    DALLAS, GA
    ZIP 30132
  • Facility Phone: 770 443-8776
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LIZA CHAPMAN
  • NPI Number: 1093730871
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2099004
LAB Type Pharmacy
Facility Name KROGER PHARMACY #673
Street 457 NATHAN DEAN BLVD
City DALLAS
State GA
ZIP 30132
Phone 770 443-8776
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 LIZA CHAPMAN

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