Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MINEER (INTERFACE MANAGER)
(513) 387-7074
Entity
Organization
Contact information
Practice address
9701 FORD AVE, RICHMOND HILL, GA 31324-6422
(912) 756-2255
(912) 756-2607
Mailing address
2175 PARKLAKE DR NE, ATLANTA, GA 30345-2845
(770) 496-5332
(770) 496-7562
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8330
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00839583A
—
GA
01
—
1146516
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/10/2006
Last updated
09/29/2009
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