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NPI Code Detail

MEDICARE: KROGER LIMITED PARTNERSHIP I

MEDICARE: KROGER LIMITED PARTNERSHIP I
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
1333600000XPharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy5845TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12160809OTHERPK

General Provider Information

NPI Number : 1558712471
Entity Type Code : Organization
Provider Name (Legal Business Name) : KROGER LIMITED PARTNERSHIP I
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 :
Provider Business Practice Location Address
First Line : 4432 VETERANS PKWY
Second Line :
City : MURFREESBORO
State : TN
Zip : 37128-3977
Country : US
Telephone Number : 615-648-8501
Fax Number : 615-648-8507
Authorized Official
Title or Position : MANAGER OF PHARMACY LICENSING
Name : ALLISON MUENNICH
Credential :
Telephone Number : 513-762-1263
Provider Enumeration Date : 06/22/2016
Last Update Date : 11/03/2016

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