11D2099858 CLIA NUMBER - KROGER PHARMACY #352

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Laboratory Demographics

CLIA Number: 11D2099858

Facility Name: KROGER PHARMACY #352

Facility Address:
455 HIGHWAY #20
LAWRENCEVILLE, GA
ZIP 30045
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Facility Phone Number: 770 962-3515

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376577106

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2099858
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #352
Street	455 HIGHWAY #20
City	LAWRENCEVILLE
State	GA
ZIP	30045
Phone	770 962-3515
CertificateType	4
CertificateEffectiveDate	8/4/2023
CertificateExpirationDate	8/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024