11D2099804 CLIA NUMBER - KROGER PHARMACY #319

Laboratory Demographics

  • CLIA Code: 11D2099804
  • Facility Name: KROGER PHARMACY #319
  • Facility Address: 7125 HIGHWAY #85
    RIVERDALE, GA
    ZIP 30274
  • Facility Phone: 770 996-3118
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1124052956
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2099804
LAB Type Pharmacy
Facility Name KROGER PHARMACY #319
Street 7125 HIGHWAY #85
City RIVERDALE
State GA
ZIP 30274
Phone 770 996-3118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2023
Certificate Expiration Date 8/2/2025
Facility Type Pharmacy
Lab Director CHUCK PAGE

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This page was last updated on: 3/20/2025