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NPI Code Detail

MEDICARE: KROGER CO OF MICHIGAN

MEDICARE: KROGER CO OF MICHIGAN
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy5301005679MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12041356OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306870142
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER CO OF MICHIGAN
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 : 108 W HIGHLAND RD
Second Line :
City : HOWELL
State : MI
Zip : 48843-1159
Country : US
Telephone Number : 517-552-0205
Fax Number : 517-552-0325
Authorized Official
Title or Position : MANAGER RX LICENSING
Name : JESSIE WARMAN
Credential :
Telephone Number : 513-762-1090
Provider Enumeration Date : 07/10/2006
Last Update Date : 01/25/2019

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Directions to “KROGER CO OF MICHIGAN ” Practice Location

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