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Provider Information for 1427253756


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KROGER LIMITED PARTNERSHIP I

Other Names:  
Doing Business As: 
SCOTTS PHARMACY J 410

Organization Subpart: NO

NPI: 1427253756
Last Updated: 2016-05-16
Certification Date:

Details

NameValue
NPI1427253756
Enumeration Date2007-06-18
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 7008 BLUFFTON RD
FORT WAYNE, IN 46809-2706
United States

Phone: 260-747-4136 | Fax:260-747-4137
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDIN200872400A
Other (non-Medicare)2025693PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyIN60006092A