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	021281100	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2078408	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497789119
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	:	855 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1975
Country	:	US
Telephone Number	:	740-393-2487
Fax Number	:	740-393-2745

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

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

Similar Medicare Providers

1699982751 — DIANNE C CARPENTER PHARMD
Practice Location Address:

855 COSHOCTON AVE
MOUNT VERNON, OH
43050-1975

Practice Phone: 740-964-5105
Practice Fax:

1891473161 — MATTHEW GIBSON PHARMD
Practice Location Address:

855 COSHOCTON AVE
MOUNT VERNON, OH
43050-1975

Practice Phone: 513-646-9484
Practice Fax:

1003950460 — OPTICARE INC
Practice Location Address:

855 COSHOCTON AVE STE 15
MOUNT VERNON, OH
43050-1975

Practice Phone: 740-392-7851
Practice Fax: 740-392-3515

1992176606 — KIMBERLY LYNETTE GLENN CNP
Practice Location Address:

855 COSHOCTON AVE STE H
MOUNT VERNON, OH
43050-1975

Practice Phone: 740-224-3922
Practice Fax:

1407381783 — DR. EMILY DANIELLE RICE PHARMD
Practice Location Address:

855 COSHOCTON AVE
MOUNT VERNON, OH
43050-1975

Practice Phone: 740-393-2487
Practice Fax:

1790210946 — DR. AMBER NICOLE WISE PHARMD, RPH
Practice Location Address:

855 COSHOCTON AVE
MOUNT VERNON, OH
43050-1975

Practice Phone: 740-393-2487
Practice Fax: 740-393-2745

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.