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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336M0002X	Mail Order Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1386391548
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 LOGISTICS AVE
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-4676
Country	:	US
Telephone Number	:	812-406-2377
Fax Number	:

Authorized Official
Title or Position	:	MANAGER OF LICENSING
Name	:	VICTORIA LYNN ANDREWS
Credential	:
Telephone Number	:	513-762-1090

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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Directions to “KROGER LIMITED PARTNERSHIP I ” Practice Location

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