Organization
THE KROGER CO
Active
Other names
Kroger Pharmacy #672
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
800 GLENWOOD AVE SE, ATLANTA, GA 30316
(470) 447-5040
(470) 447-5023
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
PHRE010295
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003177043A
—
GA
01
—
2159227
PK
—
Enumeration date
03/31/2016
Last updated
07/20/2018
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