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General NPI Number Information
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NPI Number | 1265826705
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Entity Type | Organization
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Legal Business Name | KROGER PHARMACY
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 03/23/2015
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Provider Practice Location Address
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Address Line | 16325 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91436-2101
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Country | US
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Telephone | 818-728-4515
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Fax |
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Provider Business Mailing Address
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Address Line | 3710 HAYVENHURST AVE
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City | ENCINO
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State | CA
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Zip | 91436-3844
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Country | US
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Telephone | 310-592-2846
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Fax |
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Authorized Official
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Title or Position | CLINICAL PHARMACIST
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Name | DR. LORD SORINO
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Credential |
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Telephone | 310-884-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 49773
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License Number State | CA
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