Organization
KROGER LIMITED PARTNERSHIP I
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
14346 WARWICK BLVD, NEWPORT NEWS, VA 23602-3814
(757) 877-7963
(757) 877-0663
Mailing address
3631 PETERS CREEK RD NW, ROANOKE, VA 24019-2809
(540) 563-3593
(540) 265-1211
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201003415
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008508631
—
VA
01
—
4835596
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/10/2006
Last updated
06/24/2009
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