Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY #575
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (LICENSING MANAGER)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1282 SMITHFIELD PLZ, SMITHFIELD, VA 23430-6054
(757) 357-0178
(757) 357-7581
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177168
PK
—
Enumeration date
03/30/2018
Last updated
07/19/2018
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