Healthcare Provider Details

I. General information

NPI: 1841363157
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 S REED RD
KOKOMO IN
46901-5692
US

IV. Provider business mailing address

1014 VINE ST
CINCINNATI OH
45202-1141
US

V. Phone/Fax

Practice location:
  • Phone: 765-454-5289
  • Fax: 765-454-5296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60005159
License Number StateIN
# 3
Primary TaxonomyY
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