11D2150392 CLIA NUMBER - KROGER PHARMACY #11-627

Laboratory Demographics

  • CLIA Code: 11D2150392
  • Facility Name: KROGER PHARMACY #11-627
  • Facility Address: 5550 BETHELVIEW ROAD
    CUMMING, GA
    ZIP 30040
  • Facility Phone: 678 456-4054
  • Facility Type: Other - PHARMACY
  • Facility Type: Waiver
  • Lab Director: CHUCK PAGE
  • NPI Number: 1548294382
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2150392
LAB Type Other - PHARMACY
Facility Name KROGER PHARMACY #11-627
Street 5550 BETHELVIEW ROAD
City CUMMING
State GA
ZIP 30040
Phone 678 456-4054
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Other - PHARMACY
Lab Director CHUCK PAGE

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