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NPI Code Detail

MEDICARE: THE KROGER CO

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHRE009801GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12132595OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518244482
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 : 3240 S COBB DR SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4194
Country : US
Telephone Number : 770-433-3420
Fax Number :
Authorized Official
Title or Position : MANAGER OF PHARMACY LICENSING
Name : ALLISON MUENNICH
Credential :
Telephone Number : 513-762-1019
Provider Enumeration Date : 11/07/2011
Last Update Date : 05/16/2016

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Directions to “THE KROGER CO ” Practice Location

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