11D2140576 CLIA NUMBER - KROGER PHARMACY #457

Laboratory Demographics

CLIA Number: 11D2140576

Facility Name: KROGER PHARMACY #457

Facility Address:
2700 BRASELTON HIGHWAY
DACULA, GA
ZIP 30019
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Facility Phone Number: 770 614-1022

Facility Type: Other - RETAIL PHARMACY

Certificate Type: Waiver

NPI Number: 1376577114

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2140576
LAB Type	Other - RETAIL PHARMACY
Facility Name	KROGER PHARMACY #457
Street	2700 BRASELTON HIGHWAY
City	DACULA
State	GA
ZIP	30019
Phone	770 614-1022
CertificateType	4
CertificateEffectiveDate	11/27/2023
CertificateExpirationDate	11/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024