# KROGER LIMITED PARTNERSHIP I

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kroger Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164670063
- **Authorized official:** JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1090

## Contact information

- **Practice address:** 3408 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5573
- **Practice address phone:** (601) 630-4003
- **Practice address fax:** (601) 630-4004
- **Mailing address:** PO BOX 842772, BOSTON, MA 02284-2772
- **Mailing address phone:** (513) 762-1019
- **Mailing address fax:** (513) 762-1092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 07832 | MS | Yes |

## Other

- **Enumeration date:** 09/04/2008
- **Last updated:** 03/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04875396 | — | MS |
| 01 | — | 2116834 | PK | — |