11D2099863 CLIA NUMBER - KROGER PHARMACY #367

Laboratory Demographics

  • CLIA Code: 11D2099863
  • Facility Name: KROGER PHARMACY #367
  • Facility Address: 1355 SOUTH PARK ST HWY #27
    CARROLLTON, GA
    ZIP 30117
  • Facility Phone: 770 832-9015
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1831123660
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2099863
LAB Type Pharmacy
Facility Name KROGER PHARMACY #367
Street 1355 SOUTH PARK ST HWY #27
City CARROLLTON
State GA
ZIP 30117
Phone 770 832-9015
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