Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA LANGWORTHY (MANAGER OF PHARMACY CREDENTIALING)
(513) 698-1878
Entity
Organization
Contact information
Practice address
3520 TERRY RD, JACKSON, MS 39212-4943
(601) 371-5067
(601) 371-5071
Mailing address
800 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9427
(901) 765-4157
(901) 765-4213
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0227401KJ
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330561
—
MS
01
—
2045345
PK
—
Enumeration date
07/13/2006
Last updated
04/07/2014
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