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General NPI Number Information
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NPI Number | 1942373469
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Entity Type | Organization
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Legal Business Name | KROGER TEXAS LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6479 CAMP BOWIE BLVD
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City | FORT WORTH
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State | TX
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Zip | 76116-4356
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Country | US
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Telephone | 817-738-9100
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Fax | 817-738-1957
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Provider Business Mailing Address
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Address Line | 19245 DAVID MEMORIAL DR
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City | CONROE
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State | TX
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Zip | 77385-8778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MERCHANDISER
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Name | BYRON COOLEY
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Credential |
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Telephone | 713-507-6276
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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 | 22260
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License Number State | TX
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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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Taxonomy #3
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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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