Healthcare Provider Details

I. General information

NPI: 1326072125
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: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N GETTYSBURG AVE
DAYTON OH
45417-1564
US

IV. Provider business mailing address

150 TRI COUNTY PKWY
CINCINNATI OH
45246-3217
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-0128
  • Fax: 937-268-7364
Mailing address:
  • Phone:
  • Fax:

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateOH

VIII. Authorized Official

Name: MIKE PUCCINI
Title or Position: PHARMACY MERCHANDISER
Credential:
Phone: 513-782-3384