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Organization

KROGER TEXAS L P

Active
Other names
KROGER PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
KARLA LANGWORTHY (PHARMACY LICENSING MANAGER)
(513) 698-1878
Entity
Organization

Contact information

Practice address
2400 PRESTON RD, PLANO, TX 75093-2321
(972) 596-5375
(972) 985-0522
Mailing address
19245 DAVID MEMORIAL DR, SHENANDOAH, TX 77385-8778
(713) 507-6276
(936) 442-6704

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
20250
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4580393
NCPDP PROVIDER IDENTIFICATION NUMBER
05
464597
TX
Enumeration date
11/15/2006
Last updated
09/07/2010
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