Healthcare Provider Details

I. General information

NPI: 1861426637
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: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 VILLAGE AVE
YORKTOWN VA
23693-5633
US

IV. Provider business mailing address

3631 PETERS CREEK RD NW
ROANOKE VA
24019-2809
US

V. Phone/Fax

Practice location:
  • Phone: 757-833-0406
  • Fax: 757-833-7687
Mailing address:
  • Phone: 540-563-3593
  • Fax: 540-563-1436

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 Number0201003489
License Number StateVA

VIII. Authorized Official

Name: KARLA LANGWORTHY
Title or Position: MANAGER OF PHARMACY CREDENTIALING
Credential:
Phone: 513-698-1878