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General NPI Number Information
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NPI Number | 1831640663
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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 | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 19 7TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-1734
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Country | US
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Telephone | 304-522-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 19 7TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-1734
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Country | US
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Telephone | 304-522-6677
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | CASEY LYNN SUMMERS
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Credential |
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Telephone | 304-290-7732
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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 | RP0009882
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License Number State | WV
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