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NPI Code Detail

MEDICARE: KROGER TEXAS LP

MEDICARE: KROGER TEXAS LP
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
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1407747439
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER TEXAS LP
Provider Business Mailing Address
First Line : PO BOX 830242
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19182-0352
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 E BONDS RANCH RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76131-2631
Country : US
Telephone Number : 817-484-5074
Fax Number : 817-900-8829
Authorized Official
Title or Position : LICENSING ASP
Name : VICTORIA LYNN BONE
Credential :
Telephone Number : 513-587-5303
Provider Enumeration Date : 07/09/2025
Last Update Date : 07/09/2025

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Directions to “KROGER TEXAS LP ” Practice Location

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