Healthcare Provider Details

I. General information

NPI: 1336489236
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 W MAIN ST
AMELIA OH
45102-1309
US

IV. Provider business mailing address

1014 VINE ST
CINCINNATI OH
45202-1141
US

V. Phone/Fax

Practice location:
  • Phone: 513-782-8760
  • Fax:
Mailing address:
  • Phone: 513-698-1878
  • Fax: 513-762-1092

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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