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11D2117378 CLIA NUMBER - KROGER PHARMACY #303

Laboratory Demographics

CLIA Number: 11D2117378

Facility Name: KROGER PHARMACY #303

Facility Address:
3479 MEMORIAL DRIVE
DECATUR, GA
ZIP 30032
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Facility Phone Number: 404 286-5788

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1144254970

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 11D2117378
LAB Type Pharmacy
Facility Name KROGER PHARMACY #303
Street 3479 MEMORIAL DRIVE
City DECATUR
State GA
ZIP 30032
Phone 404 286-5788
CertificateType 4
CertificateEffectiveDate 8/16/2022
CertificateExpirationDate 8/15/2024
FacilityType Waiver

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