11D2118928 CLIA NUMBER - KROGER PHARMACY #634

Laboratory Demographics

  • CLIA Code: 11D2118928
  • Facility Name: KROGER PHARMACY #634
  • Facility Address: 8876 DALLAS ACKWORTH HWY
    CASSVILLE, GA
    ZIP 30123
  • Facility Phone: 678 574-6933
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1699709402
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2118928
LAB Type Pharmacy
Facility Name KROGER PHARMACY #634
Street 8876 DALLAS ACKWORTH HWY
City CASSVILLE
State GA
ZIP 30123
Phone 678 574-6933
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Pharmacy
Lab Director CHUCK PAGE

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