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General NPI Number Information
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NPI Number | 1326917394
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Entity Type | Organization
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Legal Business Name | THE KROGER CO OF MICHIGAN
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 15100 SILVER PKWY
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City | FENTON
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State | MI
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Zip | 48430-3449
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Country | US
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Telephone | 810-208-2210
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Fax | 810-208-2205
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Provider Business Mailing Address
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Address Line | 1014 VINE ST
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City | CINCINNATI
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State | OH
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Zip | 45202-1141
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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 OF LICENSING
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Name | LYSETTE SEILHAMER
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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