11D2118931 CLIA NUMBER - KROGER PHARMACY #412

Laboratory Demographics

  • CLIA Code: 11D2118931
  • Facility Name: KROGER PHARMACY #412
  • Facility Address: 590 CASCADE ROAD
    ATLANTA, GA
    ZIP 30310
  • Facility Phone: 404 756-1144
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1659305498
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2118931
LAB Type Physician Office
Facility Name KROGER PHARMACY #412
Street 590 CASCADE ROAD
City ATLANTA
State GA
ZIP 30310
Phone 404 756-1144
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 Physician Office
Lab Director CHUCK PAGE

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