11D2127810 CLIA NUMBER - KROGER PHARMACY #422

Laboratory Demographics

  • CLIA Code: 11D2127810
  • Facility Name: KROGER PHARMACY #422
  • Facility Address: 1101 PEACHTREE PARKWAY NORTH
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 770 486-7211
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1336164011
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2127810
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #422
Street 1101 PEACHTREE PARKWAY NORTH
City PEACHTREE CITY
State GA
ZIP 30269
Phone 770 486-7211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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