MEDICARE: THE KROGER CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1053142042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KROGER CO

Provider Business Mailing Address
First Line	:	PO BOX 830242
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0352
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12116 SYCAMORE TRCE
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4400
Country	:	US
Telephone Number	:	614-504-4125
Fax Number	:	614-504-0669

Authorized Official
Title or Position	:	LICENSING MANAGER
Name	:	AMBER NICOLE WILLIAMS
Credential	:
Telephone Number	:	513-762-1090

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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Directions to “THE KROGER CO ” Practice Location

Language	Start Address	Practice Location

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