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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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12139233OTHERPK

General Provider Information

NPI Number : 1336489236
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER LIMITED PARTNERSHIP I
Provider Business Mailing Address
First Line : 1014 VINE ST
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1141
Country : US
Telephone Number : 513-698-1878
Fax Number : 513-762-1092
Provider Business Practice Location Address
First Line : 262 W MAIN ST
Second Line :
City : AMELIA
State : OH
Zip : 45102-1309
Country : US
Telephone Number : 513-782-8760
Fax Number :
Authorized Official
Title or Position : PHARMACY LICENSING MANAGER
Name : ZACH STONE
Credential :
Telephone Number : 513-762-1019
Provider Enumeration Date : 03/01/2013
Last Update Date : 07/31/2013

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Directions to “KROGER LIMITED PARTNERSHIP I ” Practice Location

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