Healthcare Provider Details

I. General information

NPI: 1548294317
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: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E COUNTY LINE RD
RIDGELAND MS
39157-1902
US

IV. Provider business mailing address

800 RIDGE LAKE BLVD
MEMPHIS TN
38120-9427
US

V. Phone/Fax

Practice location:
  • Phone: 601-956-0335
  • Fax: 601-956-0338
Mailing address:
  • Phone: 901-765-4157
  • Fax: 901-765-4213

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 Number1604012
License Number StateMS

VIII. Authorized Official

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