MEDICARE: KROGER CO OF MICHIGAN

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1326917394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KROGER CO OF MICHIGAN

Provider Business Mailing Address
First Line	:	1014 VINE ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1141
Country	:	US
Telephone Number	:	513-762-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	15100 SILVER PKWY
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-3449
Country	:	US
Telephone Number	:	810-208-2210
Fax Number	:	810-208-2205

Authorized Official
Title or Position	:	MANAGER OF LICENSING
Name	:	LYSETTE SEILHAMER
Credential	:
Telephone Number	:	513-762-1090

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	01/21/2026

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Directions to “KROGER CO OF MICHIGAN ” Practice Location

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