MEDICARE: 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
1	3336C0003X	Community/Retail Pharmacy	S012817	AZ

General Provider Information

NPI Number	:	1861897738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KROGER CO.

Provider Business Mailing Address
First Line	:	2858 N PINAL AVE
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-7917
Country	:	US
Telephone Number	:	520-426-4701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2858 N PINAL AVE
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-7917
Country	:	US
Telephone Number	:	520-426-4701
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	LOC KHAC LE
Credential	:	PHARMD
Telephone Number	:	520-426-4701

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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Directions to “KROGER CO. ” Practice Location

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