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General NPI Number Information
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NPI Number | 1801048376
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Entity Type | Organization
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Legal Business Name | KROGER TEXAS L P
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 10250 FRESNO STATE HWY 6
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City | FRESNO
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State | TX
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Zip | 77545
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Country | US
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Telephone | 281-431-6113
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Fax | 281-431-6117
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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 | 513-762-1019
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Fax | 513-762-1092
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Authorized Official
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Title or Position | MANAGER OF PHARMACY LICENSING
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Name | ALLISON MUENNICH
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Credential |
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Telephone | 513-762-1019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26082
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License Number State | TX
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