42D2111716 CLIA NUMBER - KROGER PHARMACY #640

Laboratory Demographics

  • CLIA Code: 42D2111716
  • Facility Name: KROGER PHARMACY #640
  • Facility Address: 1284 KNOX AVENUE
    NORTH AUGUSTA, SC
    ZIP 29841
  • Facility Phone: 803 442-4510
  • Facility Type: Other - RETAIL PHARMACY
  • Facility Type: Waiver
  • Lab Director: LIZA CHAPMAN
  • NPI Number: 1548414543
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2111716
LAB Type Other - RETAIL PHARMACY
Facility Name KROGER PHARMACY #640
Street 1284 KNOX AVENUE
City NORTH AUGUSTA
State SC
ZIP 29841
Phone 803 442-4510
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Other - RETAIL PHARMACY
Lab Director LIZA CHAPMAN

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