# KROGER LIMITED PARTNERSHIP I

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KROGER PHARMACY \#490
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467486241
- **Authorized official:** ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
- **Authorized official phone:** (513) 762-1019

## Contact information

- **Practice address:** 6745 S SIWELL RD, BYRAM, MS 39272-8747
- **Practice address phone:** (601) 863-2004
- **Practice address fax:** (601) 863-2016
- **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 | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 6584012 | MS | Yes |

## Other

- **Enumeration date:** 07/10/2006
- **Last updated:** 05/16/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08627538 | — | MS |
| 01 | — | 2047210 | PK | — |