Organization
THE KROGER CO
Active
Other names
Kroger Pharmacy #639
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER NICOLE WILLIAMS (LICENSING MANAGER)
(513) 762-1090
Entity
Organization
Contact information
Practice address
1006 MARTINS CHAPEL RD, LAWRENCEVILLE, GA 30045-6644
(770) 496-5332
Mailing address
PO BOX 830424, PHILADELPHIA, PA 19182-0530
(770) 496-5332
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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