Healthcare Provider Details

I. General information

NPI: 1588698385
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: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 E OHIO PIKE # SR125
AMELIA OH
45102-2007
US

IV. Provider business mailing address

150 TRI COUNTY PKWY
CINCINNATI OH
45246-3217
US

V. Phone/Fax

Practice location:
  • Phone: 513-797-5340
  • Fax: 513-797-4326
Mailing address:
  • Phone: 513-782-3384
  • Fax: 513-782-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number021042450
License Number StateOH

VIII. Authorized Official

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