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Organization

KROGER TEXAS LP

Active
Other names
Kroger Pharmacy
Organization subpart
No

Provider details

NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization

Contact information

Practice address
2608 W FM 544, WYLIE, TX 75098-4938
(972) 244-7681
(972) 244-7683
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
28513
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2139474
PK
05
466916
TX
Enumeration date
03/19/2013
Last updated
05/16/2016
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