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NPI Code Detail

MEDICARE: KROGER TEXAS L P

MEDICARE: KROGER TEXAS L P
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy20200TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12096127OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063585586
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER TEXAS L P
Provider Business Mailing Address
First Line : PO BOX 842772
Second Line :
City : BOSTON
State : MA
Zip : 02284-2772
Country : US
Telephone Number : 513-762-1019
Fax Number : 513-762-1092
Provider Business Practice Location Address
First Line : 6200 HIGHWAY 6 SOUTH
Second Line :
City : MISSOURI CITY
State : TX
Zip : 77459-3803
Country : US
Telephone Number : 281-208-1741
Fax Number : 281-208-1744
Authorized Official
Title or Position : MANAGER OF LICENSING
Name : VICTORIA LYNN ANDREWS
Credential :
Telephone Number : 937-728-8628
Provider Enumeration Date : 11/15/2006
Last Update Date : 12/15/2021

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Directions to “KROGER TEXAS L P ” Practice Location

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