11D2129427 CLIA NUMBER - KROGER PHARMACY # 625

Laboratory Demographics

  • CLIA Code: 11D2129427
  • Facility Name: KROGER PHARMACY # 625
  • Facility Address: 461 S COLUMBIA AVENUE
    RINCON, GA
    ZIP 31326
  • Facility Phone: (912) 584-7140
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1306202890
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2129427
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY # 625
Street 461 S COLUMBIA AVENUE
City RINCON
State GA
ZIP 31326
Phone 9125847140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Other - RETAIL PHARMACY
Lab Director CHUCK PAGE

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This page was last updated on: 5/18/2026