# KROGER LIMITED PARTNERSHIP I

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- **Entity:** Organization
- **Status:** Active
- **Other names:** KROGER PHARMACY J-888
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871666495
- **Authorized official:** MATT MINEER (INTERFACE MANAGER)
- **Authorized official phone:** (513) 387-7074

## Contact information

- **Practice address:** 201 E BIDWELL ST, TAYLORVILLE, IL 62568-1361
- **Practice address phone:** (217) 287-7391
- **Practice address fax:** (217) 287-7440
- **Mailing address:** 5960 CASTLEWAY WEST DR, INDIANAPOLIS, IN 46250-1977
- **Mailing address phone:** (317) 579-8434
- **Mailing address fax:** (317) 579-8424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054015081 | IL | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 12/14/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1476452 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |