Healthcare Provider Details

I. General information

NPI: 1659607141
Provider Name (Legal Business Name): KROGER LIMITED PARTNERSHIP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 N BROADWAY ST
KNOXVILLE TN
37918-2345
US

IV. Provider business mailing address

PO BOX 842772
BOSTON MA
02284-2772
US

V. Phone/Fax

Practice location:
  • Phone: 865-686-1020
  • Fax: 865-656-1021
Mailing address:
  • Phone: 513-762-1019
  • 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 Number0000004680
License Number StateTN

VIII. Authorized Official

Name: LYSETTE SEILHAMER
Title or Position: PHARMACY LICENSING MANAGER
Credential:
Phone: 515-762-1090