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NPI Code Detail

MEDICARE: THE KROGER CO

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy7857GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22019141OTHERPK

General Provider Information

NPI Number : 1568496305
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE KROGER CO
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 : 4321 HARTLEY BRIDGE RD
Second Line :
City : MACON
State : GA
Zip : 31216-5641
Country : US
Telephone Number : 478-788-1015
Fax Number : 478-788-2050
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 : 04/21/2025

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Directions to “THE KROGER CO ” Practice Location

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