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11D2117447 CLIA NUMBER - KROGER PHARMACY #378

Laboratory Demographics

CLIA Number: 11D2117447

Facility Name: KROGER PHARMACY #378

Facility Address:
220 TOM MILL SR BLVD
MACON, GA
ZIP 31210
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Facility Phone Number: 478 474-7597

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1639194319

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 11D2117447
LAB Type Pharmacy
Facility Name KROGER PHARMACY #378
Street 220 TOM MILL SR BLVD
City MACON
State GA
ZIP 31210
Phone 478 474-7597
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