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General NPI Number Information
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NPI Number | 1891729679
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Entity Type | Organization
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Legal Business Name | KROGER LIMITED PARTNERSHIP I
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/07/2014
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Provider Practice Location Address
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Address Line | 5601 HIGH ST W
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3758
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Country | US
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Telephone | 757-686-8527
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Fax | 757-686-5260
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Provider Business Mailing Address
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Address Line | 3631 PETERS CREEK RD NW
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City | ROANOKE
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State | VA
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Zip | 24019-2809
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Country | US
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Telephone | 540-563-3593
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Fax | 540-563-1436
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Authorized Official
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Title or Position | MANAGER OF PHARMACY CREDENTIALING
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Name | KARLA LANGWORTHY
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Credential |
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Telephone | 513-698-1878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201003508
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License Number State | VA
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