11D2099859 CLIA NUMBER - KROGER PHARMACY #354

Laboratory Demographics

  • CLIA Code: 11D2099859
  • Facility Name: KROGER PHARMACY #354
  • Facility Address: 1232 SOUTH HAIRSTON RD
    STONE MOUNTAIN, GA
    ZIP 30088
  • Facility Phone: 404 292-5542
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1528092228
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2099859
LAB Type Pharmacy
Facility Name KROGER PHARMACY #354
Street 1232 SOUTH HAIRSTON RD
City STONE MOUNTAIN
State GA
ZIP 30088
Phone 404 292-5542
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Pharmacy
Lab Director CHUCK PAGE

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