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NPI Code Detail

MEDICARE: KROGER LIMITED PARTNERSHIP I

MEDICARE: KROGER LIMITED PARTNERSHIP I
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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPO7355KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32122877OTHERPK

General Provider Information

NPI Number : 1295064731
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER LIMITED PARTNERSHIP I
Provider Business Mailing Address
First Line : PO BOX 842772
Second Line :
City : BOSTON
State : MA
Zip : 02284-2772
Country : US
Telephone Number : 513-762-1019
Fax Number : 513-762-1092
Provider Business Practice Location Address
First Line : 130 PAVILION PKWY
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2998
Country : US
Telephone Number : 859-292-5680
Fax Number : 859-292-5681
Authorized Official
Title or Position : MANAGER PHARMACY LICENSING
Name : JESSIE WARMAN
Credential :
Telephone Number : 513-762-1090
Provider Enumeration Date : 12/11/2009
Last Update Date : 02/04/2020

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