MEDICARE: KROGER TEXAS L P

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	22259	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2097881	OTHER		PK

General Provider Information

NPI Number	:	1497828719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KROGER TEXAS L P

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	:	7201 BOULEVARD 26
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8605
Country	:	US
Telephone Number	:	817-281-8310
Fax Number	:	817-427-8281

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

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/18/2021

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Directions to “KROGER TEXAS L P ” Practice Location

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