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Organization
KROGER CO
Active
Organization
KROGER CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
2010 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5206
(337) 990-4902
(337) 990-4904
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
7474
LA
Other
Enumeration date
02/08/2017
Last updated
03/15/2018
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