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	020824900	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2073708	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376577072
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	:	1500 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2632
Country	:	US
Telephone Number	:	419-756-7023
Fax Number	:	419-756-7425

Authorized Official
Title or Position	:	MANGER PHARMACY LICENSING
Name	:	JESSIE WARMAN
Credential	:
Telephone Number	:	513-762-1090

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	02/06/2020

Similar Medicare Providers

1689655573 — MARIAN STRAUB RPH
Practice Location Address:

1500 LEXINGTON AVE
MANSFIELD, OH
44907-2632

Practice Phone: 419-756-7023
Practice Fax:

1467905760 — LUCY LEIENDECKER PHARMD
Practice Location Address:

1500 LEXINGTON AVE
MANSFIELD, OH
44907-2632

Practice Phone: 419-756-7023
Practice Fax:

1710412937 — DR. JO ELLEN COBB PHARMD
Practice Location Address:

1500 LEXINGTON AVE
MANSFIELD, OH
44907-2632

Practice Phone: 419-756-7023
Practice Fax:

1881129500 — MICHELLE HATHAWAY RPH
Practice Location Address:

1500 LEXINGTON AVE
MANSFIELD, OH
44907-2632

Practice Phone: 419-756-7023
Practice Fax:

1134128804 — DESOTO PARISH AMBULANCE SERVICE DISTRICT
Practice Location Address:

208 GIBBS ST
MANSFIELD, LA
71052-2632

Practice Phone: 318-872-0221
Practice Fax: 318-872-5997

1417077033 — A J&B HERMAN ENTERPRISE, INC.
Practice Location Address:

1162 PARK AVE E , STATE RT #430
MANSFIELD, OH
44905-2632

Practice Phone: 419-756-9799
Practice Fax: 419-756-7308

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.