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General NPI Number Information
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NPI Number | 1174557920
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Entity Type | Organization
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Legal Business Name | KROGER CO OF MICHIGAN
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 66900 GRATIOT AVE
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City | RICHMOND
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State | MI
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Zip | 48062-1913
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Country | US
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Telephone | 586-727-0125
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Fax | 586-727-0406
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Provider Business Mailing Address
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Address Line | PO BOX 842772
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City | BOSTON
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State | MA
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Zip | 02284-2772
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Country | US
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Telephone | 513-762-1090
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Fax |
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Authorized Official
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Title or Position | MANAGER RX LICENSING
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Name | JESSIE WARMAN
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Credential |
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Telephone | 513-762-1090
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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 | 5301007398
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License Number State | MI
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