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General NPI Number Information
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NPI Number | 1508146010
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Entity Type | Organization
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Legal Business Name | KROGER SPECIALTY PHARMACY FL 2 LLC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 6435 HAZELTINE NATIONAL DR STE 140
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City | ORLANDO
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State | FL
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Zip | 32822-5156
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Country | US
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Telephone | 855-274-1694
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Fax | 855-819-6922
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Provider Business Mailing Address
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Address Line | 6435 HAZELTINE NATIONAL DR STE 140
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City | ORLANDO
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State | FL
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Zip | 32822-5156
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Country | US
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Telephone | 855-274-1694
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Fax | 855-819-6922
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DEBRA J COLE
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Credential |
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Telephone | 855-733-3126
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH25629
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License Number State | FL
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