Healthcare Provider Details

I. General information

NPI: 1871739771
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 E 71ST ST
INDIANAPOLIS IN
46220-4002
US

IV. Provider business mailing address

PO BOX 842772
BOSTON MA
02284-2772
US

V. Phone/Fax

Practice location:
  • Phone: 317-813-1903
  • Fax: 317-813-1904
Mailing address:
  • Phone: 513-762-1019
  • Fax: 513-762-1092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60006187A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALLISON MUENNICH
Title or Position: MANAGER OF PHARMACY LICENSING
Credential:
Phone: 513-762-1019