Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY #678
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
1028 ROBERTS BRANCH PKWY, COLUMBIA, SC 29203
(803) 234-7150
(803) 234-2212
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160067
PK
—
Enumeration date
05/11/2016
Last updated
07/20/2018
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