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General NPI Number Information
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NPI Number | 1003840810
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Entity Type | Organization
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Legal Business Name | THE KROGER CO
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 9701 FORD AVE
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City | RICHMOND HILL
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State | GA
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Zip | 31324-6422
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Country | US
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Telephone | 912-756-2255
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Fax | 912-756-2607
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Provider Business Mailing Address
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Address Line | 2175 PARKLAKE DR NE
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City | ATLANTA
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State | GA
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Zip | 30345-2845
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Country | US
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Telephone | 770-496-5332
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Fax | 770-496-7562
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Authorized Official
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Title or Position | INTERFACE MANAGER
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Name | MATT MINEER
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Credential |
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Telephone | 513-387-7074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 8330
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License Number State | GA
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