Healthcare Provider Details

I. General information

NPI: 1205860020
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E EUCLID AVE
LEXINGTON KY
40502-1740
US

IV. Provider business mailing address

1600 ORMSBY STATION CT
LOUISVILLE KY
40223-4039
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-3331
  • Fax: 859-266-8868
Mailing address:
  • Phone: 502-423-4113
  • Fax: 502-423-4176

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 Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1775
License Number StateKY

VIII. Authorized Official

Name: ZACH STONE
Title or Position: PHARMACY LICENSING MANAGER
Credential:
Phone: 513-762-1019