Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
Kroger Pharmacy #401
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
4375 BRAMBLETON AVE, ROANOKE, VA 24018-3404
(540) 772-0605
(540) 772-0601
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201003350
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063896991
—
VA
01
—
2153031
PK
—
Enumeration date
07/09/2015
Last updated
07/28/2016
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