Healthcare Provider Details

I. General information

NPI: 1770014672
Provider Name (Legal Business Name): THE KROGER CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9997 CARVER RD 4THFLOOR CPP
BLUE ASH OH
45242
US

IV. Provider business mailing address

9997 CARVER RD 4THFLOOR CPP
BLUE ASH OH
45242-5537
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number03227941
License Number StateOH

VIII. Authorized Official

Name: KENNETH HOFFMAN
Title or Position: OPERATIONS MANAGER CPP
Credential:
Phone: 513-867-5050