44D1059929 CLIA NUMBER - KROGER PHARMACY 25-433

Laboratory Demographics

  • CLIA Code: 44D1059929
  • Facility Name: KROGER PHARMACY 25-433
  • Facility Address: 11630 HWY 51 S ATTN PHARMACY
    ATOKA, TN
    ZIP 38004
  • Facility Phone: 901 837-5010
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MARC WATKINS
  • NPI Number: 1639273733
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D1059929
LAB Type Pharmacy
Facility Name KROGER PHARMACY 25-433
Street 11630 HWY 51 S ATTN PHARMACY
City ATOKA
State TN
ZIP 38004
Phone 901 837-5010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Pharmacy
Lab Director DR. MARC WATKINS

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