11D2126149 CLIA NUMBER - KROGER PHARMACY #672

Laboratory Demographics

  • CLIA Code: 11D2126149
  • Facility Name: KROGER PHARMACY #672
  • Facility Address: 800 GLENWOOD AVENUE, SE
    ATLANTA, GA
    ZIP 30316
  • Facility Phone: 470 447-5040
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1043673650
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2126149
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #672
Street 800 GLENWOOD AVENUE, SE
City ATLANTA
State GA
ZIP 30316
Phone 470 447-5040
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2025
Certificate Expiration Date 2/20/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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