Healthcare Provider Details

I. General information

NPI: 1396818910
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E STATE BLVD
FORT WAYNE IN
46805-3224
US

IV. Provider business mailing address

1014 VINE ST
CINCINNATI OH
45202-1141
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-1731
  • Fax: 260-424-1672
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005171
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW FELTMAN
Title or Position: MGR PHARMACY INTERFACE
Credential:
Phone: 513-762-1095