Organization
KROGER SPECIALTY PHARMACY, INC.
Active
Other names
Kroger Specialty Pharmacy CA 3
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA J COLE (VICE PRESIDENT)
(855) 733-3126
Entity
Organization
Contact information
Practice address
1821 KAISER AVE, IRVINE, CA 92614-5707
(855) 733-3126
(888) 315-3270
Mailing address
1821 KAISER AVE, IRVINE, CA 92614-5707
(855) 733-3126
(888) 315-3270
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
PHY51548
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092265
—
AZ
05
—
1184649782
—
CA
05
—
1184649782
—
ID
05
—
1184649782
—
UT
05
—
140622100
—
WY
05
—
1626534
—
AK
05
—
2043938
—
WA
05
—
60000708
—
NM
05
—
7176839
—
MT
05
—
94789061
—
CO
Enumeration date
07/13/2006
Last updated
05/08/2020
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