Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
LYSETTE SEILHAMER (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
378 MARKETPLACE PKWY, DAWSONVILLE, GA 30534-7266
(470) 375-1995
(470) 375-1996
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008126
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00753222A
—
GA
01
—
2019877
PK
—
Enumeration date
07/10/2006
Last updated
12/05/2023
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