11D2117420 CLIA NUMBER - KROGER PHARMACY #374

Laboratory Demographics

  • CLIA Code: 11D2117420
  • Facility Name: KROGER PHARMACY #374
  • Facility Address: 2100 RIVERSIDE PARKWAY
    LAWRENCEVILLE, GA
    ZIP 30043
  • Facility Phone: 770 962-1197
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1285668012
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2117420
LAB Type Pharmacy
Facility Name KROGER PHARMACY #374
Street 2100 RIVERSIDE PARKWAY
City LAWRENCEVILLE
State GA
ZIP 30043
Phone 770 962-1197
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: 6/4/2025