MEDICARE: THE KROGER CO

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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	6053	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2014768	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316971138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KROGER CO

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	:	1310 POWERS FERRY RD SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5410
Country	:	US
Telephone Number	:	404-496-7860
Fax Number	:	770-933-8414

Authorized Official
Title or Position	:	MANAGER OF PHARMACY LICENSING
Name	:	LYSETTE SEILHAMER
Credential	:
Telephone Number	:	513-762-1019

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	04/21/2025

Similar Medicare Providers

1649874942 — LAURA PYRONNEAU
Practice Location Address:

1310 POWERS FERRY RD SE
MARIETTA, GA
30067-5410

Practice Phone: 404-496-7860
Practice Fax:

1467387910 — RENEW HEALTHCARE
Practice Location Address:

1640 POWERS FERRY RD SE BUILDING 19, STE 350
MARIETTA, GA
30067-5491

Practice Phone: 215-266-2560
Practice Fax:

1942135363 — LAKEISHA WILLIAMS
Practice Location Address:

1640 POWERS FERRY RD SE STE 100
MARIETTA, GA
30067-5491

Practice Phone: 630-740-9946
Practice Fax:

1578499646 — SHARESE HARRISON
Practice Location Address:

2470 WINDY HILL RD SE STE 417
MARIETTA, GA
30067-8625

Practice Phone: 678-280-4308
Practice Fax:

1982530697 — SIERRA PETERSON
Practice Location Address:

1640 POWERS FERRY RD SE STE 100
MARIETTA, GA
30067-5491

Practice Phone: 404-362-7442
Practice Fax:

1700719812 — MRS. GLORIA FAYELYN BILODEAU MSW
Practice Location Address:

1640 POWERS FERRY RD SE # 4
MARIETTA, GA
30067-5491

Practice Phone: 678-336-6875
Practice Fax:

Directions to “THE KROGER CO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.