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Provider Information for 1720012610


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THE KROGER CO

Other Names:  
Doing Business As: 
KROGER PHARMACY

Organization Subpart: NO

NPI: 1720012610
Last Updated: 2016-05-16
Certification Date:

Details

NameValue
NPI1720012610
Enumeration Date2006-07-10
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: ALLISON MUENNICH
Title: MANAGER OF PHARMACY LICENSING
Phone: 5137621019
Mailing Address PO BOX 842772
BOSTON, MA 02284-2772
United States

Phone: 513-762-1019 | Fax:513-762-1092
 
Primary Practice Address 6555 SUGARLOAF PKWY STE 200
DULUTH, GA 30097-4929
United States

Phone: 770-418-2398 | Fax:770-814-9168
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2020158PK
MEDICAIDGA00808959A
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 333600000X - Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyGA8271