Healthcare Provider Details

I. General information

NPI: 1881628519
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: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 RIVERDALE RD
MEMPHIS TN
38115-4406
US

IV. Provider business mailing address

150 TRI COUNTY PKWY
CINCINNATI OH
45246-3217
US

V. Phone/Fax

Practice location:
  • Phone: 901-366-3970
  • Fax: 901-366-3971
Mailing address:
  • Phone: 513-782-3384
  • Fax: 513-782-8760

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 Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberC3163
License Number StateTN

VIII. Authorized Official

Name: MATT MINEER
Title or Position: INTERFACE MANAGER
Credential:
Phone: 513-387-7074