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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	60005156	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2026407	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588737100
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	:	513-762-1092

Provider Business Practice Location Address
First Line	:	1217 E IRELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46614-3448
Country	:	US
Telephone Number	:	574-291-0740
Fax Number	:	574-299-4314

Authorized Official
Title or Position	:	MANAGER OF PHARMACY LICENSING
Name	:	ALLISON MUENNICH
Credential	:
Telephone Number	:	513-762-1019

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	05/16/2016

Similar Medicare Providers

1568454940 — SHERI A WILSON PA-C
Practice Location Address:

1245 E IRELAND RD
SOUTH BEND, IN
46614-3448

Practice Phone: 743-127-0225
Practice Fax:

1851937767 — KELLY GAIL RACEK PHARMD
Practice Location Address:

1217 E IRELAND RD
SOUTH BEND, IN
46614-3448

Practice Phone: 574-291-0740
Practice Fax:

1700423563 — MS. LINDA RENEE SIMMONS
Practice Location Address:

1217 E IRELAND RD
SOUTH BEND, IN
46614-3448

Practice Phone: 574-291-0666
Practice Fax:

1962123075 — KRISTINA MARIE CRESPO PA-C
Practice Location Address:

1245 E IRELAND RD
SOUTH BEND, IN
46614-3448

Practice Phone: 574-312-7022
Practice Fax:

1396684767 — DR. DELYN MOUA DC
Practice Location Address:

4753 FIRESTONE BLVD
SOUTH GATE, CA
90280-3448

Practice Phone: 323-310-2217
Practice Fax:

1245357607 — SANDRA MCCLENDON CUMMINGS LLMSW
Practice Location Address:

5555 CONNER ST , SUITE 1000 SOUTH
DETROIT, MI
48213-3448

Practice Phone: 313-347-2067
Practice Fax:

Directions to “KROGER LIMITED PARTNERSHIP I ” 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.