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Organization
THE KROGER CO
Active
Organization
THE KROGER CO
Active
Other names
Kroger Pharmacy #533
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
9484 ELLERBE RD STE 100, SHREVEPORT, LA 71106
(318) 517-6973
(318) 517-6976
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007389-RC
LA
Other
Enumeration date
06/23/2016
Last updated
07/20/2018
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