11D2099802 CLIA NUMBER - KROGER PHARMACY #315

Laboratory Demographics

  • CLIA Code: 11D2099802
  • Facility Name: KROGER PHARMACY #315
  • Facility Address: 134 BANKS CROSSING
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 404 463-4201
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1134153042
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2099802
LAB Type Prison
Facility Name KROGER PHARMACY #315
Street 134 BANKS CROSSING
City FAYETTEVILLE
State GA
ZIP 30214
Phone 404 463-4201
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Prison
Lab Director CHUCK PAGE

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