11D2117412 CLIA NUMBER - KROGER PHARMACY #373

Laboratory Demographics

  • CLIA Code: 11D2117412
  • Facility Name: KROGER PHARMACY #373
  • Facility Address: 8059 TARA BOULEVARD
    JONESBORO, GA
    ZIP 30236
  • Facility Phone: 770 478-6353
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1215952098
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2117412
LAB Type Pharmacy
Facility Name KROGER PHARMACY #373
Street 8059 TARA BOULEVARD
City JONESBORO
State GA
ZIP 30236
Phone 770 478-6353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2024
Certificate Expiration Date 8/15/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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